Vault prolapse after vaginal hysterectomy with pelvic floor repair for uterovaginal prolapse

Abstract

Introduction: Utero-vaginal prolapse is the most common gynaecological pathology among the Neplease women. Many women in Nepal are the unable to get the treatment of this pathology due to their poor economical conditions (1,2). However since last few years many governmental and nongovernmental organizations are organizing hysterectomy camps in rural areas of Nepal to help these poor people.

Objective: To compare the incidence of vault prolapse among the women underwent vaginal hysterectomy with pelvic floor repair for different degree of utero-vaginal prolapse in hysterectomy camps.

Methods: It was Prospective comparative study, done on 1646 women in different nine districts of Nepal from June 1999 to May 2009.All the Patientssubjected to the vaginal hysterectomy for different degree of utero-vaginal prolapse were grouped in to two groups selecting the patients alternatively. In first group of the patients during anterior colporraphy bladder wassupported by interrupted bladder buttressing stitches and in second group this repair was done by applying single purse string stitch including the apex of the vagina and incidence of vault prolapse was compared in two groups after two years of the surgery in follow up camps.

Results: Out of 1646 operated patients 891 came for follow up. Among these women 567 were from group A (interrupted suture group) and325 patients were from the Group B (single purse string) group. From group A there were 22 cases and from group B 4cases of vault prolapse. In both the groups majority of the women were chronic smoker. And majority of them started heavy work after one month of prolapse surgery in both the groups.

Conclusion: Single purse string suture seems better technique for the support of the bladder or as a whole vault during the anterior colporraphy while doing the pelvic floor repair in cases of uterovaginal prolapse, especially in the camp set up.