Non-Oral Poster 89: The Risk Factors for Failed Vaginal Hysterectomies

Abstract

OBJECTIVE:We present the surgical anatomy and steps to perform the uterosacral ligament vaginal vault suspension. METHODS: Video taping of cadaver dissection, laparoscopic surgery, and vaginal surgery is combined to demonstrate the surgical anatomy and steps of suspending the apex of the vaginal to the uterosacral ligaments for treatment of uterine or apical prolapse. The relationship of the uterosacral ligament and the ureter is presented. Color illustrations and animation compliment the presentation of the procedure. RESULTS: The uterosacral ligament vaginal vault procedure provides a vaginal approach to achieving bilateral apical support directed in the normal axis of the vagina. CONCLUSION: This video presents a detailed description of the surgical anatomy and steps of the uterosacral ligament vaginal vault procedure. OBJECTIVE:To demonstrate the purpose and technique of the Extended (colpo-) Perineorrhaphy (EP), a minimally invasive operation for severe prolapse in elderly acoital women. METHODS: A modification of the old Martius Labhardt vulvoplasty was developed to offer a definitive, albeit obliterative, option to treat grades 3 and 4 pelvic organ prolapse (Baden-Walker system) in surgically at risk acoital patients. Patients were offered this operation after having failed or refused pessary care. The technique was designed to accomplish marked narrowing of the genital hiatus, tightening of the distended introitus, and creation of an exaggerated perineum; thus preventing prolapse exteriorization. The steps included: 1) excision of perineal and distal posterior vaginal skin, 2) levator plication, 3) deep connective tissue closure, 4) running closure of posterior vaginal and labial skin, and 5) wide crown stitches to create an exaggerated perineum. The EP was performed in 24 patients and their intra and postoperative courses were observed for subjective and objective cure or improvement and complications. A video was made to demonstrate the detailed technique of this procedure. RESULTS: The operation was successful in curing prolapse symptoms either alone or with the aide of an easily maintained pessary. In a review of 24 at risk acoital patients at a mean of 17 months (range, 3-75), in 16 (67%) their prolapse remained intra-vaginal, in 6 (25%) the prolapse was exteriorized but improved and they were now able to hold a pessary, and the remaining 2 cases (8%) were failures. Postop complications included 1-anemia with transfusion, 2 (8.3%) cellulitis and 3 (12.5%) partial breakdowns. Two of these 5 local healing problems required re-closure. Success defined by prolapse intra-vaginal with or without a pessary and no symptoms was 92%. CONCLUSION: The EP alone is a safe and effective operation for the cure of exteriorized prolapse in acoital women. Because of the inherent superficial nature of this procedure, it can be expected to have a shorter operative time, blood loss, hospital stay and recuperation when compared with the standard full reconstructive operation. The acoital patient formally relinquishes her v...