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A Modified Method of Surgical Repair for Prolapse of Cervical Stump with Associated Enterocele
A MODIFIED METHOD OF SURGICAL REPAIR FOR PROLAPSE OF CERVICAL STUMP WITH ASSOCIATED ENTEROCELE DAVID RosE, 1\i.IJ.,
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rFrom thf' :l1o·unl .1nbu.m Hosvita.l,
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HE prolapse of a eervical stump following supra vaginal hystereetomy is
Volume;,
Number 2
f4UR
was then used, carrying the left strip to the right subpubic fascia. Thus was constructed crossed layers of denuded mucosa and fascia sutured to the subpubic fascia, in the fashion of sliding grafts, creating a sling under the transposed cervical flap. The excess vaginal mucosa was trimmed off and sutured together from below the urethra down to the point where the top of the plication of the uterosacral ligaments had been started. The posterior vaginal mucosa was then trimmed and sutured to the bottom edges of the anterior layer. A high perineal repair was then completed in the usual manner. Upon completion, the reconstructed vaginal tube admitted two fingers and extended about three inches in depth. A retention catheter was placerl in the bladder and the patient returned to bed in good condition. 'l'he postoperative convalescence was uneventful, and the patient was discharged home on the thirteenth postoperative day. Examination on discharge revealed a well-healed perineum. The vagina admitted two fingers. The anterior vaginal wall was healed, and there was no bulge on straining. A thick ridge could be felt under the s~'mphysis puhis, and the vaginal canal was patent for about three inches. There was no bulging or relaxation at the dome of the vagina. Re-examination, flix months later, revealed no change.
Summary A typical case of prolapsed cervical stump with associated enterocele and cystocele following abdominal supravaginal hysterectomy is described. A modified method of repair utilizing- sliding fascial-mucosal grafts and transposition nf cervical flap is described. cl83 BEACON STREET
Bmno~,
l\L-\:,;:::;.
rFrom thf' :l1o·unl .1nbu.m Hosvita.l,
T
HE prolapse of a eervical stump following supra vaginal hystereetomy is
Volume;,
Number 2
f4UR
was then used, carrying the left strip to the right subpubic fascia. Thus was constructed crossed layers of denuded mucosa and fascia sutured to the subpubic fascia, in the fashion of sliding grafts, creating a sling under the transposed cervical flap. The excess vaginal mucosa was trimmed off and sutured together from below the urethra down to the point where the top of the plication of the uterosacral ligaments had been started. The posterior vaginal mucosa was then trimmed and sutured to the bottom edges of the anterior layer. A high perineal repair was then completed in the usual manner. Upon completion, the reconstructed vaginal tube admitted two fingers and extended about three inches in depth. A retention catheter was placerl in the bladder and the patient returned to bed in good condition. 'l'he postoperative convalescence was uneventful, and the patient was discharged home on the thirteenth postoperative day. Examination on discharge revealed a well-healed perineum. The vagina admitted two fingers. The anterior vaginal wall was healed, and there was no bulge on straining. A thick ridge could be felt under the s~'mphysis puhis, and the vaginal canal was patent for about three inches. There was no bulging or relaxation at the dome of the vagina. Re-examination, flix months later, revealed no change.
Summary A typical case of prolapsed cervical stump with associated enterocele and cystocele following abdominal supravaginal hysterectomy is described. A modified method of repair utilizing- sliding fascial-mucosal grafts and transposition nf cervical flap is described. cl83 BEACON STREET