Abdominal hysterectomy with or without angle stitch: correlation with subsequent vaginal vault prolapse.
OBJECTIVE
The objective of the study was to assess whether cardinal-uterosacral ligament lateral vaginal cuff angle stitches at the time of total hysterectomy may assist in preventing subsequent apical vault prolapse.


METHODS
Total hysterectomies without cuff angle stitches were performed in 7 unembalmed cadavers. Successive hanging weights of 1, 2, 3, and 4 kg were loaded against the vaginal cuff and distances moved were recorded. The same process was repeated after tying bilateral angle stitches.


RESULTS
Average distances pulled with 1, 2, 3, and 4 kg of traction against the cuff without angle stitches were 14.6 +/- 1.4, 19.1 +/- 1.7, 23.1 +/- 2.3, and 27.6 +/- 2.0 mm, respectively. After completing angle sutures, these distances were 13.1 +/-1.1, 17.3 +/- 1.5, 20.9 +/- 1.9, and 25.1 +/- 2.6 mm, respectively (P = .026).


CONCLUSIONS
Methodical incorporation of the cardinal-uterosacral ligaments into the vaginal cuff margins at time of total abdominal hysterectomy may help minimize subsequent apical vault prolapse.
Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
David D
DD
Rahn
Rebecca J
RJ
Stone
Andy K
AK
Vu
Amanda B
AB
White
Clifford Y
CY
Wai
D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001696:Biomechanical Phenomena; D001956:Broad Ligament / Q000601:surgery; D002102:Cadaver; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects / Q000379:methods*; D007813:Laparotomy / Q000009:adverse effects / Q000379:methods; D011336:Probability; D012404:Round Ligament of Uterus / Q000601:surgery; D012680:Sensitivity and Specificity; D013536:Suture Techniques; D013718:Tensile Strength; D014596:Uterine Prolapse / Q000517:prevention & control*