OBJECTIVES: Numerous techniques have been described for supporting the vaginal vault after enterocele repair and hysterectomy. We describe a transvaginal culdosuspension that obliterates the cul-de-sac and supports the vaginal cuff high on the levator plate. The normal vaginal axis is restored, and adequate vaginal depth is provided for normal sexual activity. METHODS: One hundred four patients, aged 48 to 90 years (mean age 71), underwent transvaginal culdosuspension in conjunction with enterocele repair (62 patients), vaginal hysterectomy (20 patients), or both (22 patients). Two culdosuspension sutures support the vaginal vault to the origin of the sacrouterine and cardinal ligaments, and the cul-de-sac is obliterated with two pursestring sutures. Concomitant prolapse was repaired in 82 patients, bladder neck suspension in 50, cystocele repair in 45, and rectocele repair in 76. RESULTS: One hundred patients were followed up at a mean of 17.3 months (range 6.5 to 35). Recurrence of enterocele or vault prolapse occurred in 4 patients. All patients who had preoperative stress incontinence were cured of leakage. Complications were rare, and there were no instances of vaginal foreshortening, urinary retention, vaginal skin necrosis, bladder perforation, or rectovaginal fistula. CONCLUSIONS: Transvaginal culdosuspension is a safe and effective procedure for treating and preventing enterocele and vaginal vault prolapse. This technique restores the normal vaginal depth and axis, resulting in a sexually functional vagina.
OBJECTIVES: Numerous techniques have been described for supporting the vaginal vault after enterocele repair and hysterectomy. We describe a transvaginal culdosuspension that obliterates the cul-de-sac and supports the vaginal cuff high on the levator plate. The normal vaginal axis is restored, and adequate vaginal depth is provided for normal sexual activity. METHODS: One hundred four patients, aged 48 to 90 years (mean age 71), underwent transvaginal culdosuspension in conjunction with enterocele repair (62 patients), vaginal hysterectomy (20 patients), or both (22 patients). Two culdosuspension sutures support the vaginal vault to the origin of the sacrouterine and cardinal ligaments, and the cul-de-sac is obliterated with two pursestring sutures. Concomitant prolapse was repaired in 82 patients, bladder neck suspension in 50, cystocele repair in 45, and rectocele repair in 76. RESULTS: One hundred patients were followed up at a mean of 17.3 months (range 6.5 to 35). Recurrence of enterocele or vault prolapse occurred in 4 patients. All patients who had preoperative stress incontinence were cured of leakage. Complications were rare, and there were no instances of vaginal foreshortening, urinary retention, vaginal skin necrosis, bladder perforation, or rectovaginal fistula. CONCLUSIONS: Transvaginal culdosuspension is a safe and effective procedure for treating and preventing enterocele and vaginal vault prolapse. This technique restores the normal vaginal depth and axis, resulting in a sexually functional vagina.