title: Efficacy of a standardized technique of trans-vaginal entry into the peritoneal cavity for post-hysterectomy vaginal vault suspension.
abstract: The aim of this paper is to describe the efficacy and safety of a standardized technique of trans-vaginal entry into the peritoneal cavity for post-hysterectomy vault prolapse and determine how well the pre-operative pelvic examination predicted successful peritoneal entry. A retrospective review of patients undergoing post-hysterectomy trans-vaginal apical suspensions using a standardized technique of peritoneal entry was employed in this study. A subset of patients underwent a standardized pre-operative evaluation to predict what organ was behind the vaginal cuff and posterior cul-de-sac. Peritoneal entry was attempted in 280 patients, and successfully achieved in 223(80%). One cystotomy and one proctotomy (0.3%) occurred during attempted entry. Of those who underwent the standardized pre-operative evaluation, peritoneal entry was successful 86% of the time when small bowel was predicted to lie behind the vaginal cuff or posterior cul-de-sac. Peritoneal entry can be safely achieved in the majority of post-hysterectomy prolapse patients. Pre-operative examination assists in predicting successful peritoneal entry.
authors.affiliation: Department of Gynecology & Obstetrics, Section of Female Pelvic Medicine & Reconstructive Surgery, Cleveland Clinic, Cleveland, OH 44195, USA. parka@ccf.org
authors.forename: Amy J
authors.initials: AJ
authors.lastname: Park
authors.forename: Beri
authors.initials: B
authors.lastname: Ridgeway
authors.forename: A Marcus
authors.initials: AM
authors.lastname: Gustilo-Ashby
authors.forename: Marie Fidela R
authors.initials: MF
authors.lastname: Paraiso
authors.forename: Mark D
authors.initials: MD
authors.lastname: Walters
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Barber
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D008875:Middle Aged; D010529:Peritoneal Cavity / Q000601:surgery*; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures / Q000379:methods*; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome; D014596:Uterine Prolapse / Q000209:etiology / Q000601:surgery*; D014621:Vagina / Q000601:surgery*