[Abdominal sacrocolpopexy in surgical treatment of complete vaginal vault prolapse after hysterectomy].
BACKGROUND
The vaginal vault prolapse after hysterectomy is a complex disorder, which can be associated with the prolapse of anterior or posterior vaginal wall or cystorectocele. The exact incidence is unknown, and is within the range from 1 - 43% of operated patients. In order to achieve the complete surgical reconstruction of the pelvic floor disorder, a surgeon must have good knowledge of normal anatomic relations of pelvic organs.


METHODS
Twenty-nine women with the vaginal vault prolapse after hysterectomy were operated at Clinic for Gynecology and Obstetrics in Novi Sad during the period fiom 1995 - 2007. After standard preoperative procedures, positioning of the patient and inferior medial abdominal incision, the supportive graft made of non-resorptive materials was fixed to the vaginal fornix and sacral periost from the promontory to the level of S 3-4 vertebrae.


RESULTS
The average age of the patients was 61.4 years. The following supportive materials were used: mersilen mesh (16), allograft made of m. rectus abdominis fascia (5), prolen (4), fascia lata strip (2) and common Silk sutures (2). Additional operations (Moschowitz Douglasoraphy, Kelly-Marion anterior vaginal repair, colpoperineoplasty and Burchcolposuspension) were performed in 20 (68.9%) patients.


CONCLUSIONS
There were 7 (23.8%) postoperative complications. The erosion of mersilen mesh was detected in 2 (6.8%) patients, and recurrence of vaginal vault prolaps and cystorectocele in 3 (10.2%) patients. According to other authors, the erosion of synthetic materials occurs in about 3.4%, and recurrence of vaginal vault prolaps in 0-22% of operated patients.


CONCLUSIONS
The complete vaginal vault prolaps after hysterectomy is a complex anatomic disorder which has a great impact on the life quality and significantly disturbs patient s psychosocial sphere. Surgical treatment involves abdominal or vaginal access and is planned individually for each patient.
Durdević
Srdan
S
Klinika za ginekologiju i akuserstvo, Klinicki centar Vojvodine, Novi Sad. winter@eunet.yu
Vejnović
Tihomir
T
Curcić
Aleksandar
A
Mladenović-Segedi
Ljiljana
L
Maksimović
Marko
M
D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D008875:Middle Aged; D014596:Uterine Prolapse / Q000209:etiology / Q000601:surgery*; D014621:Vagina / Q000473:pathology