Vaginal McCall culdoplasty versus laparoscopic uterosacral plication to prophylactically address vaginal vault prolapse

Abstract

BackgroundStudies have shown that vaginal vault prolapse can affect up to 43% of women following hysterectomy for pelvic organ prolapse. Many techniques have been described to prevent and treat vaginal vault prolapse. The primary objective of our study was to compare McCall’s culdoplasty (when performed along side vaginal hysterectomy) with laparoscopic uterosacral plication (when performed along side total laparoscopic hysterectomy) for prevention of vaginal vault prolapse. Secondary outcomes included inpatient stay and perioperative complications.A retrospective comparison study comparing 73 patients who underwent ‘laparoscopic hysterectomy and uterosacral plication’ against 70 patients who underwent ‘vaginal hysterectomy and McCall culdoplasty’. All operations were carried out by two trained surgeons.ResultsThere was no significant difference between BMI or parity. There were statistically significantly more patients presenting with post hysterectomy vault prolapse (PHVP) in the group of patients who had undergone uterosacral plication (12 out of 73) compared with McCalls culdoplasty (0 out of 70) P = 0.000394. Inpatient stay in the uterosacral plication group was significantly shorter mean 1.8 compared to 3.6 for McCall group (P-Value is <0.00001). There was no significance in the perioperative complications between both groups (P = 0.41).ConclusionsMcCalls is a superior operation to prevent PHVP compared to uterosacral plication with no difference in terms of perioperative complications.

The role of transforming growth factor-ß (TGF-ß1) in postmenopausal women with pelvic organ prolapse: An immunohistochemical study

“…Based on a large community based retrospective cohort study, factors that increase the risk of POP are older age, postmenopausal status, parity, elevated intraabdominal pressure and overweight [ [10] , [11] , [12] ]. Additionally, it seems that a combination of support defects in the anterior, posterior, and apical vaginal segments, abnormalities of connective tissue structure or its repair mechanism might predispose women to the development of POP [ 10 , 11 , 13 ]. It is well accepted that the USL plays an important role in the pelvic support system, with quantity, structure and organization of the extracellular matrix (ECM) being key elements of the tissue’s stability [ 14 ].…”

Prevention of vaginal vault prolapse occurrences post vaginal and abdominal hysterectomy. An evidence based case report.

“…However, Shull procedure is proven better in terms of sexual function. Along with Schiavi et al 7 , the study by Niblock et al 8 also showed a low percentage in vaginal vault prolapse occurrence following McCall culdoplasty procedure (0%). Otherwise, in USP procedure, vaginal vault prolapse occurrence rate following hysterectomy were higher (16.4%).…”

“…In contrast to Schiavi et al 7 , the study performed Niblock et al 8 had a shorter follow-up period, with a mean of follow-up was 36 months for McCall culdoplasty group and 41 months for laparoscopic USP group; whilst the shortest follow-up period is 5 months. The relatively short follow-up periods could be a source of bias due to the possible occurrence of vaginal vault prolapse in this period was still low.…”

“…In terms of validity, the three studies did not perform randomization because of the inapplicable study design. Studies by Schiavi et al 7 and Niblock et al 8 used retrospective cohort design meanwhile the study by Pal et al 9 only had one trial group. In their studies, Schiavi et al 7 and Niblock et al 8 used two groups with same characteristics which have been proven not to differ significantly by a series of statistical calculation.…”

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

“…They were found to be comparable in terms of the complications encountered. Laparoscopic uterosacral plication has a statistically significant shorter hospital admission, but MC has proven to be superior to laparoscopic uterosacral plication in terms of patients presenting with subsequent pelvic organ prolapse [24]. Another study reported that laparoscopic uterosacral ligament colpopexy appears to achieve a good anatomical outcome and is safer and more reliable than the transvaginal approach [25].…”