Efficacy of a standardized technique of trans-vaginal entry into the peritoneal cavity for post-hysterectomy vaginal vault suspension |
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Authors: | Amy J Park Beri Ridgeway A Marcus Gustilo-Ashby Marie Fidela R Paraiso Mark D Walters Matthew D Barber |
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Institution: | (1) Section of Female Pelvic Medicine & Reconstructive Surgery, Department of Gynecology & Obstetrics, Cleveland Clinic, 9500 Euclid Ave Desk A81, Cleveland, OH 44195, USA |
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Abstract: | The aim of this paper is to describe the efficacy and safety of a standardized technique of trans-vaginal entry into the peritoneal
cavity for post-hysterectomy vault prolapse and determine how well the pre-operative pelvic examination predicted successful
peritoneal entry. A retrospective review of patients undergoing post-hysterectomy trans-vaginal apical suspensions using a
standardized technique of peritoneal entry was employed in this study. A subset of patients underwent a standardized pre-operative
evaluation to predict what organ was behind the vaginal cuff and posterior cul-de-sac. Peritoneal entry was attempted in 280
patients, and successfully achieved in 223(80%). One cystotomy and one proctotomy (0.3%) occurred during attempted entry.
Of those who underwent the standardized pre-operative evaluation, peritoneal entry was successful 86% of the time when small
bowel was predicted to lie behind the vaginal cuff or posterior cul-de-sac. Peritoneal entry can be safely achieved in the
majority of post-hysterectomy prolapse patients. Pre-operative examination assists in predicting successful peritoneal entry. |
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Keywords: | Vaginal vault suspension Culdoplasty Post-hysterectomy vaginal vault prolapse |
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