During the study period from January 2008 to December 2012, 177 women had transvaginal sacrospinous ligament fixation (SSF) for vault suspension at General Hospital Kuala Lumpur. Of the 177 women, 133 (75.1%) had severe uterovaginal prolapse while 44 (24.9%) had post-hysterectomy vault prolapse. All patients with severe uterovaginal prolapse and rectocele undergone vaginal hysterectomy and posterior colporrhaphy respectively. A hundred and seventy-four patients (98.3%) had anterior repair whilst 48 (27.1%) received midurethral sling as concomitant procedure to vault suspension (SSF). The mean duration of surgery was 92.1±30.2 minutes and the mean estimated blood loss was 319±199.3mls. There was no surgical mortality. Two patients (1.1%) had rectal injuries. No patient had bladder injury or de novo urinary symptoms. The commonest immediate postoperative complications was fever (98; 55.4%) followed by buttock pain in 18 (10.2%) patients. Both complications were resolved with conservative measures. Seven patients (3.9%) had sutures erosion as late complications. Of the 177 women, 158 (89.3%) and 141 (79.7%) came for the 6 and 12 months follow-up, respectively. The success rate for all three compartments ranged from 92.4% to 98.1% at 6 months and reduced to range from 85.7% to 94.4% at 12 months. The highest success rate was observed in the posterior compartment followed by apical and anterior compartment. Equally, the recurrence rate was lowest in the posterior compartment (1.9%), followed by the central (3.8%) and anterior compartment (7.5%) at 6 months’ review. This increased to 5.7% for rectocele, 7.8% for vault prolapse and 14.2% for cystocele at 12 months’ follow-up. None had repeated surgery for prolapse recurrence during the study period. In conclusion, SSF remains a high priority in our therapeutic regime for the treatment of severe uterovaginal and vault prolapse as it has a reasonably good success rate with lower serious complications in the skillful hands.
Hysterectomy, Vaginal

No abstract available.
Female ; Hysterectomy* ; Hysterectomy, Vaginal*

No abstract available.
Female ; Hysterectomy, Vaginal*

No abstract available.
Female ; Hysterectomy, Vaginal*

No abstract available.
Female ; Hysterectomy, Vaginal*

No abstract available.
Female ; Hysterectomy, Vaginal*

No abstract available.
Female ; Hysterectomy, Vaginal* ; Uterine Prolapse*

Background: The rate of prolapse recurrence after vaginal hysterectomy ranges from 6% to 12%. Vaginal vault fixation procedures like the iliococcygeus fixation and the cul-de-sac obliteration (McCall culdoplasty) have been used to address the loss of apical support in patients with advanced-stage prolapse to prevent this recurrence. Objectives: This study aims to assess the rate of prolapse recurrence and risk factors for recurrence as well as urinary, bowel, and sexual symptoms in women who have undergone vaginal hysterectomy with and without vaginal vault fixation for pelvic organ prolapse stage 2 or higher. Methods: This study is a retrospective study that included patients with pelvic organ prolapse stage 2 or greater who underwent vaginal hysterectomy with and without vaginal vault fixation from 2009 to 2014 seen at the urogynecology clinic of a Philippine tertiary referral center. The cohorts were divided into those with iliococcygeal fixation (n=171) and those without (n=83). The Z test of mean difference was used in comparing average values between the two groups. Chi-square test of independence was used in comparing the proportion of patients as stratified by various variables and their corresponding groups, while some variables were adjusted for 2x2 Fischer Exact test. Any associated p-value less than 0.05 alpha were considered statistically significant. Results: Of the 876 patients operated on for prolapse between 2009 to 2014, 254 were included in the study. They were divided into those with iliococcygeal fixation (n=171) and those without (n=83). Recurrence was significantly lower in the group who underwent iliococcygeal fixation (23.39% vs 36.14%, p=0.037) after a median follow-up of 28.98 months for those with fixation and 31.08 for those without. The posterior compartment prolapse recurrence rate is higher in those without fixation (16.87% vs 6.43%, p=0.013). Longer duration of menopause (16.96 ± 7.16 vs 13.37 ± 7.1, p=0.001), unemployment (52.85% vs 36.41%, p=0.22) and longer time from surgery (37.84 ± 15.69 vs 26.55 ± 12.59, p=0.000) were significantly associated with recurrence. Moreover, higher pre- (6.24 ± 1.41 vs 5.78 ± 0.95, p=0.003) and post-operative genital hiatus (4.53 ± 0.97 vs 4.23 ± 0.54, p=0.002) and shorter pre-operative perineal body (1.86 ± 0.35 vs 1.97 ± 0.35, p=0.025) measurements were also significantly associated with recurrence. Both groups have no significant difference in urinary, sexual or bowel symptoms. Conclusion Iliococcygeus fixation is an effective method of preventing prolapse recurrence. Increased duration of menopause, longer time from surgery, longer genital hiatus, and shorter perineal body all contribute to recurrence. Moreover, urinary, sexual and bowel symptoms do not differ significantly between those with and without iliococcygeus fixation. Thus performing prophylactic vaginal vault fixation should be contemplated in patients undergoing prolapse surgery, with careful consideration of patient factors and potential morbidities.
Pelvic Organ Prolapse ; Recurrence ; Hysterectomy, Vaginal

OBJECTIVE: Recent advances in laparoscopic surgery have allowed to substitute Laparoscopic Assisted Vaginal Hysterectomy for classical abdominal hysterectomy. The purpose of this study was to evaluate the effectiveness and the value of hysteroscopic procedure which was helpful in taking directed biopsies of malignant suspected areas of endometrium before LAVH. METHODS: We compared hysteroscopic biopsy results with permanent biopsy results after LAVH in 100 patients (group A). In addition, we considered hysteroscopic biopsy results of 60 patients (group B) who had abnormal endometrial findings in vaginal ultrasonography. RESULTS: No endometrial malignant lesion was found between hysteroscopic biopsies and permanent pathologic results after LAVH in the study group A. The malignant hysteroscopic biopsy results of the study group B was about 25%. CONCLUSION: Hysteroscopic procedure for detecting endometrial malignant lesion before LAVH in large uterine tumors could be used. But this study provided that preoperative vaginal sonography was sufficient to evaluate endometrial condition.
Biopsy ; Endometrium ; Female ; Humans ; Hysterectomy ; Hysterectomy, Vaginal* ; Hysteroscopy* ; Laparoscopy ; Ultrasonography

The importance of minimal invasive surgery has increased. Interest in vaginal hysterectomy is rising. Controversy remains regarding the value of conservation of the cervix at hysterectomy. These factors stimulate interest in subtotal vaginal hysterectomy (SVH). SVH is a simple procedure that carries a low risk of morbidity. It can be an option in the treatment of patient with benign conditions of the uterine corpus who desire the retention of the cervix. This desire may arise from concern about possible subsequent bowel, urinary, sexual dysfunction, as well as from other non-clinical issues. We performed SVH in two patients of uterine leiomyoma. Our report includes a brief review of literature.
Cervix Uteri ; Female ; Humans ; Hysterectomy ; Hysterectomy, Vaginal* ; Leiomyoma