Transabdominal partial vaginal resection and infundibulopelvic colpopexy for posthysterectomy vaginal vault prolapse

OBJECTIVE: To assess abdominal partial resection of the vagina and infundibulopelvic colpopexy in women with posthysterectomy vaginal vault prolapse. STUDY DESIGN: After laparotomy, the elongated vaginal wall was resected, and sutures with absorbable surgical suture material were used to close the vagina, which was suspended by the sutures placed into the infundibulopelvic, sacrouterine and round ligaments. The surgical site was covered and elevated by the overlapping peritoneum. Over 15 years (July 1990-July 2005), the procedure was performed on 74 women (aged 28-84 years; mean age at the time of surgery, 58.5 years) due to vaginal eversion developing after abdominal (24 cases) or vaginal (39) hysterectomy, supravaginal amputation (4) or abdominal colpopexy (7). RESULTS: Perioperative complications included entry into the bladder (2.6%) and transitory voiding difficulty (6.7%). There was no bowel injury. Patients were followed annually by pelvic examination; in 1 of 74 patients, vaginal eversion partly recurred, and a repeat colpopexy was performed. All the patients have a functional vagina without urinary incontinence, pelvic pain or other pelvic discomfort. CONCLUSION: This safe and reliable intervention should be performed only by gynecologists trained in surgery on the pelvic retroperitoneum and parametrium.