Sacrospinous ligament fixation and modified McCall culdoplasty during vaginal hysterectomy for advanced uterovaginal prolapse☆,☆☆
Section snippets
Material and methods
During the period from November 1987 through May 1993, 65 women admitted to our department for the correction of advanced uterovaginal prolapse underwent vaginal hysterectomy and reconstructive pelvic surgery, which included sacrospinous ligament fixation. Three patients were lost to follow-up and were thereafter excluded from this study, leaving 62 cases available for evaluation. A review was made of the computerized records of a further 317 women who underwent surgery with the same indication
Results
As would be expected from the selection process, no significant differences were seen between the 2 groups in the characteristics examined (Table I).
Empty Cell Sacrospinous ligament fixation (n = 62) Matched controls with modified McCall culdoplasty (n = 62) Statistical significance Uterine prolapse (No.) Grade 2 24 (39%) 22 (36%) Grade 3 38 (61%) 40 (64%) P = .87* Age (y) 56.9 ± 7.8 (40–76) 58.4 ± 8.7 (40–77) P = .31† Parity (median, range) 2 (1–10) 2 (1–12) P = .43‡
Comment
The use of sacrospinous suspension as a prophylactic measure in conjunction with vaginal hysterectomy is controversial, and no comparative study is available in the literature.2 We used an individually matched design to compare sacrospinous ligament fixation and modified McCall culdoplasty in women with advanced uterovaginal prolapse. Data were taken from a computerized data collection exercise that has taken place at our center since 1986 and was specifically instituted by the first author
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Cited by (117)
McCall culdoplasty vs. vaginally assisted laparoscopic sacrocolpopexy in the treatment of advanced uterine prolapse: A randomized controlled study
2023, Taiwanese Journal of Obstetrics and GynecologyFixation of uterosacral ligaments to anterior vaginal wall during modified McCall culdoplasty after vaginal hysterectomy
2022, European Journal of Obstetrics and Gynecology and Reproductive BiologyLong-Term Experience with Modified McCall Culdoplasty in Women Undergoing Vaginal Hysterectomy for Pelvic Organ Prolapse
2021, Journal of Obstetrics and Gynaecology CanadaCitation Excerpt :Techniques described include McCall culdoplasty, sacrospinous ligament fixation, and Shull suspension.14–16 The modified McCall culdoplasty as described by Colombo and Milani16 has been shown to be superior to sacrospinous ligament fixation in reducing apical recurrence. The technique of McCall culdoplasty was first described by McCall in 1957 as a treatment for uterovaginal prolapse,17 with various subsequent modifications by other surgeons.
Comparison of two natural tissue repair-based surgical techniques; sacrospinous fixation and uterosacral ligament suspension for pelvic organ prolapse treatment
2021, Journal of Gynecology Obstetrics and Human ReproductionComparison of patient reported outcomes, pelvic floor function and recurrence after laparoscopic sacrohysteropexy versus vaginal hysterectomy with McCall suspension for advanced uterine prolapse
2020, European Journal of Obstetrics and Gynecology and Reproductive BiologyCitation Excerpt :Despite its common use, the debate on its effectiveness in advanced stage prolapse still goes on. Several reports have described VH and cuff suspension as an insufficient procedure for advanced prolapse and have suggested that its use should be limited to mild to moderate prolapse [3,4,15]. However, recently Alas et al. assessed the success rates of VH&McCall in women with advanced and less severe uterine prolapse and found similar success and reoperation rates [16].
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From the Division of Gynecology, Department of Obstetrics and Gynecology, San Gerardo Hospital, Third Branch of the University of Milan.
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