Affiliation:
1. Klinika za ginekologiju i akušerstvo, Klinički centar Vojvodine, Novi Sad
Abstract
Introduction 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. Material and 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 from 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. Discussion 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. Conclusion 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.
Publisher
National Library of Serbia