[Abdominal partial resection of the vagina and colpopexy: experiences with the procedure for posthysterectomy vault prolapse in 74 cases].
OBJECTIVE
To assess the abdominal partial resection of the vagina and infundibulopelvic colpopexia in women with posthysterectomy vaginal vault prolapse. OPERATIVE PROCEDURE AND MATERIAL: Slightly modifying the method described by Lampé, after laparotomy the elongated vaginal wall is resected and the vaginal vault is fixed by the sutures placed into the infundibulopelvic, sacrouterine, and round ligaments. The area is covered and elevated by the overlapping peritoneum. During the last 15 years (July 1990 - July 2005) the procedure was offered and performed in 74 women because of vaginal eversion (aged 28 to 84 years; average age at operation was 58.5 years) after abdominal (24 cases) or vaginal (39 cases) hysterectomy or supravaginal amputation (4 cases) or abdominal colpopexy (7 cases). In 16 cases, anterior or posterior colporrhaphy were subsequently performed because of cystocele or rectocele or both.


RESULTS
Perioperative complications included two bladder injury (2.6%), and transitory voiding difficulty in five cases (6.7%). There was neither bowel nor ureter injury. Patients were followed up annually by pelvic examination; in one of the 74 patients the vaginal eversion partly relapsed and the colpopexy was repeated. In one patient 18 months later because of intraabdominal adhesions a laparotomy and adhesiolysis was performed. All patients have a functional vagina without urinary incontinence and without pelvic pain or any pelvic discomfort.


CONCLUSIONS
The abdominal partial resection of the vagina and colpopexy to the pelvic ligaments seems simpler than other techniques that are commonly used and a safe and reliable operation for the correction of posthysterectomy vault prolapse and enterocele. A long term follow up is necessary to detect any late complications. The operation should be made only by gynecologists trained in the surgery of pelvic retroperitoneum.
Semmelweis Egyetem, Altalános Orvostudományi Kar, I. Szülészeti es Nogyógyászati Klinika, Budapest. pz@noi1.sote.hu
Zoltán
Z
Papp
Gábor
G
Mezei
János
J
Hidvégi
Petronella
P
Hupuczi
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D008875:Middle Aged; D011391:Prolapse; D012189:Retrospective Studies; D016896:Treatment Outcome; D014621:Vagina / Q000473:pathology* / Q000601:surgery*