Verma Aruna, Kashyap Monika, Gupta Abhilasha
Department of Obstetrics and Gynaecology, Lala Lajpat Rai Memorial (LLRM) Medical College, Meerut, IND.
Department of Obstetrics and Gynaecology, Venkateshwara Institute of Medical Sciences, Gajraula, IND.
Cureus. 2022 Jul 27;14(7):e27368. doi: 10.7759/cureus.27368. eCollection 2022 Jul.
There are high chances of post-hysterectomy vault prolapse (PHVP) if the vault is not well supported after vaginal hysterectomy in cases of pelvic organ prolapse (POP). High uterosacral ligament suspension (HUSLS) and McCall's culdoplasty are the well-recommended modalities to suspend the vault after vaginal hysterectomy. As both the procedures are accessible to non-urologic gynaecologists, the study was planned in cases of POP. Objective: The study was conducted to compare the anatomic and functional outcomes of patients undergoing vaginal HUSLS vs. McCall's culdoplasty at the time of vaginal hysterectomy.
This prospective interventional study was done in a tertiary care hospital. A total of 80 patients were included and divided into two groups of 40 patients each. In one group, patients underwent high uterosacral ligament suspension and in the second group, McCall's culdoplasty was done for vault suspension. All procedures were done by two trained surgeons. The effectiveness of both the procedures was assessed by preoperative and postoperative pelvic organ prolapse quantification (POP-Q) (up to two years). Patients were followed for two years to see for any postoperative problem/recurrence.
Vault suspension by HUSLS showed better results than McCall's culdoplasty, in terms of POP-Q point C, perineal body (PB), genital hiatus (GH) and total vaginal length (TVL) as compared to McCall's culdoplasty.
The anatomical correction is much better with HUSLS, which suspends the vault in the normal vaginal axis. However, it takes longer compared to McCall's culdoplasty, so the procedure should be individualised and performed with several precautions.
在盆腔器官脱垂（POP）病例中，若阴道子宫切除术后穹窿未得到良好支撑，则发生子宫切除术后穹窿脱垂（PHVP）的可能性很高。高位骶子宫韧带悬吊术（HUSLS）和麦考尔直肠子宫陷凹成形术是阴道子宫切除术后悬吊穹窿的常用推荐方法。由于这两种手术非泌尿外科妇科医生均可操作，因此针对POP病例开展了本研究。目的：本研究旨在比较阴道子宫切除术时接受阴道HUSLS与麦考尔直肠子宫陷凹成形术患者的解剖学和功能结局。
本前瞻性干预性研究在一家三级护理医院进行。共纳入80例患者，分为两组，每组40例。一组患者接受高位骶子宫韧带悬吊术，另一组进行麦考尔直肠子宫陷凹成形术以悬吊穹窿。所有手术均由两名经过培训的外科医生完成。通过术前和术后盆腔器官脱垂定量（POP-Q）（最长两年）评估两种手术的有效性。对患者进行为期两年的随访，观察术后是否有任何问题/复发情况。
与麦考尔直肠子宫陷凹成形术相比，就POP-Q的C点、会阴体（PB）、生殖裂孔（GH）和阴道总长度（TVL）而言，HUSLS悬吊穹窿的效果更好。
HUSLS在正常阴道轴线上悬吊穹窿，其解剖学矫正效果更好。然而，与麦考尔直肠子宫陷凹成形术相比，该手术耗时更长，因此手术应个体化并在采取多项预防措施的情况下进行。
