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Rivista di Ostetricia e Ginecologia

Indexed/Abstracted in: EMBASE, PubMed/MEDLINE, Scopus, Emerging Sources Citation Index



Minerva Ginecologica 2018 Jan 26

DOI: 10.23736/S0026-4784.18.04191-6


lingua: Inglese

Transvaginal native-tissue repair of vaginal vault prolapse

Rodolfo MILANI 1, Matteo FRIGERIO 1, Francesca L. VELLUCCI 2, Stefania PALMIERI 1, Federico SPELZINI 3, Stefano MANODORO 1

1 Department of Obstetrics and Gynaecology, San Gerardo Hospital, University of Milano- Bicocca, Monza, Italy; 2 University of Siena, Siena, Italy; 3 Department of Obstetrics and Gynaecology, Infermi Hospital, Rimini, Italy


BACKGROUND: Post-hysterectomy vaginal vault prolapse repair is a challenge for pelvic floor surgeons. Native-tissue repair procedures imply lower costs and reduced morbidity. Our study aims to evaluate operative data, complications, objective, subjective and functional outcomes of transvaginal native-tissue repair for post-hysterectomy vaginal vault prolapse. We also investigated differences among available techniques.
METHODS: Retrospective study including patients with symptomatic vaginal vault prolapse (≥ stage 2), previously treated with transvaginal vault suspension through native-tissue repair. Objective recurrence was defined as the descent of at least one compartment ≥ II stage according to POP-Q system or need of reoperation. Subjective recurrence was defined as the presence of bulging symptoms. Patients satisfaction was evaluated with PGI-I score.
RESULTS: 111 patients were analyzed. Apical suspension was achieved either by uterosacral ligament suspension (16), levator myorrhaphy (17), iliococcygeus fascia fixation (65) or sacrospinous ligament fixation (13). No intraoperative complications were observed. Perioperative/postoperative complications occurred in 8 patients (7.2%). Mean follow up was 24.5±12.1 months. Objective recurrence was observed in 28 patients (25.2%). Reintervention was required by 3 patients (2.7%). Subjective recurrence was referred by 6 patients (5.4%). Mean satisfaction evaluated with PGI-I score was 1.2±0.6. No differences in terms of operative data, overall complications, objective, subjective cure rate and perceived satisfaction were found among different techniques.
CONCLUSIONS: Transvaginal repair with native-tissue procedures is safe and effective in correcting post-hysterectomy vaginal vault prolapse and represents a valid alternative to prosthetic procedures for vaginal vault prolapse treatment.

KEY WORDS: Uterosacral ligament suspension - Levator myorrhaphy - Iliococcygeus fascia fixation - Sacrospinous ligament fixation - Vaginal vault prolapse

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Publication History

Article first published online: January 26, 2018
Manuscript accepted: January 15, 2018
Manuscript received: December 28, 2017

Per citare questo articolo

Milani R, Frigerio M, Vellucci FL, Palmieri S, Spelzini F, Manodoro S. Transvaginal native-tissue repair of vaginal vault prolapse. Minerva Ginecol 2018 Jan 26. DOI: 10.23736/S0026-4784.18.04191-6

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