E-Posters-Modified High McCall Vaginal Cuff Suspension for Stage 3-4 Uterine Prolapse at the time of Vaginal Hysterectomy - Importance of High Uterosacral/Cardinal Ligament Vault Suspension and Meticulous Closure of Large Levator Hiatal Defects

Modified High McCall Vaginal Cuff Suspension for Stage 3-4 Uterine Prolapse at the time of Vaginal Hysterectomy - Importance of High Uterosacral/Cardinal Ligament Vault Suspension and Meticulous Closure of Large Levator Hiatal Defects - Ariel Zilberlicht, MD

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The objective of this study was to evaluate the long-term results of a modified high McCall culdoplasty technique for stage 3-4 uterine prolapse during vaginal hysterectomy. The researchers aimed to assess the success rate of this technique without the need for additional sacrospinous fixation.<br /><br />METHODS<br /><br />This retrospective clinical study was conducted between 2000 and 2017 at a urogynecology center. Standardized questionnaires and examinations were used for initial evaluation and follow-up, using the POP-Q or Baden-Walker system. All surgeries were performed by the same surgeon or under his supervision.<br /><br />RESULTS<br /><br />Out of 219 cases found, 176 met the inclusion criteria. The mean follow-up period was 19.35 months. Recurrence of stage 2 or above was diagnosed in 25 cases (14%), with 19 (76%) being asymptomatic. The recurrences primarily occurred at the anterior wall (48%) and posterior wall (25%), with some involving multiple compartments. Only 3% of the cases required further surgery, all of which had recurrent enterocele.<br /><br />CONCLUSIONS<br /><br />The modified McCall technique for vault suspension during hysterectomy for advanced pelvic organ prolapse had a good long-term success rate without the need for sacrospinous fixation. Only a small percentage of cases required further surgery for symptoms, which were primarily related to recurrent enterocele. The authors emphasized the importance of high uterosacral/cardinal ligament vault suspension and meticulous closure of large levator hiatal defects for successful surgical outcomes in procidentia repair.

Keywords

McCall culdoplasty technique

uterine prolapse

vaginal hysterectomy

long-term results

sacrospinous fixation

retrospective study

recurrence

anterior wall

posterior wall

pelvic organ prolapse