Prophylactic McCall Culdoplasty by a Vaginal Approach during Mini-Laparoscopic Hysterectomy

Abstract

Background. In gynecological surgery, one particular area of concern after hysterectomy is the risk of developing an enterocele or vaginal apical prolapse. The aims of this study were to evaluate the safety and efficacy of prophylactic McCall culdoplasty (MC) performed during mini-total laparoscopic hysterectomy (mini-TLH), as well as to compare the differences in apical support, total vaginal length (TVL), and sexual function at one and two years postoperatively. Methods. Data were retrospectively reviewed for all women who underwent mini-TLH and mini-TLH + MC at a tertiary care center between August 2012 and January 2016 were from the hospital database. There were 18 women who underwent mini-TLH + MC and were considered as the study group, while 20 women who were treated with mini-TLH were considered as the control group. The primary outcome measures were the differences in apical support and TVL and impact on sexual function. Results. After mini-TLH + MC, the apical vaginal support difference was improved by 2.2 cm. The mean difference in C point was 1.03 cm in the mini-TLH group, which was not significant at two years after the operation. The vaginal vault descent at two years after operation was more prominent in the mini-TLH group than the mini-TLH + MC groups. Apical support changes at two years after the operation were more prominent in the mini-TLH group (0.5 ± 0.6 cm) than the mini-TLH + MC group (1.9 ± 1.2 cm). Conclusion. Prophylactic MC by a vaginal approach during mini-TLH is safe, satisfactory, and efficient for apical support without severe morbidity.

The effectiveness of surgical procedures to prevent post-hysterectomy pelvic organ prolapse: a systematic review of the literature

“…The six studies included in our review comprise a total of 719 women aged between 18 and 100 years and 10 different surgical procedures. Five of these 10 surgical procedures were performed as part of vaginal hysterectomy [ 41 – 43 ], 3 procedures were performed as part of laparoscopic hysterectomy [ 44 , 45 ], and 2 procedures were performed as part of abdominal hysterectomy [ 46 ]. Two studies compared women undergoing a specific prophylactic surgical procedure with a control group of women without a prophylactic procedure during hysterectomy [ 41 , 44 ].…”

“…Five of these 10 surgical procedures were performed as part of vaginal hysterectomy [ 41 – 43 ], 3 procedures were performed as part of laparoscopic hysterectomy [ 44 , 45 ], and 2 procedures were performed as part of abdominal hysterectomy [ 46 ]. Two studies compared women undergoing a specific prophylactic surgical procedure with a control group of women without a prophylactic procedure during hysterectomy [ 41 , 44 ]. Only 3 studies were designed as a prospective trial [ 41 , 44 , 45 ], of which only 1 included a control group with no suspension during hysterectomy [ 41 ].…”

“…Two studies compared women undergoing a specific prophylactic surgical procedure with a control group of women without a prophylactic procedure during hysterectomy [ 41 , 44 ]. Only 3 studies were designed as a prospective trial [ 41 , 44 , 45 ], of which only 1 included a control group with no suspension during hysterectomy [ 41 ]. Further, 1 study was an observational–longitudinal–cohort study [ 43 ], whereas the rest were retrospective data analyses.…”

“…Gencdal et al performed a retrospective observational study of 38 women, 18 of which had undergone laparoscopic hysterectomy with McCall culdoplasty (LH-McCall), and 20 had undergone laparoscopic hysterectomy without the McCall culdoplasty (LH) [ 44 ]. In the LH-McCall group, first the vaginal cuff was closed laparoscopically and the McCall culdoplasty was performed using a vaginal approach.…”