Management of Pelvic Organ Prolapse by Vincenzo Li Marzi & Maurizio Serati

Author:Vincenzo Li Marzi & Maurizio Serati
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

8.2.1 McCall Culdoplasty

In 1957, McCall described the technique of closing the deep cul-de-sac at the time of vaginal hysterectomy to prevent enterocele formation [6]. Since then, other surgeons have modified the procedure, incorporating the uterosacral ligaments for apical support. This is the most frequently performed technique to close the posterior vaginal cuff, especially in surgical interventions for moderate POP cases involving vaginal hysterectomy.

The modified McCall culdoplasty is performed by placing one or two delayed absorbable suture through one of the uterosacral ligaments, incorporating the cul-de-sac peritoneum and vaginal cuff, and placing the final suture through the opposite uterosacral ligament [7]. It is uncertain if nonabsorbable sutures provide higher rates of cure; they do however result in more suture erosions [8]. Many authorities advocate using this procedure as part of every vaginal hysterectomy, even in the absence of prolapse, to minimize future formation of apical prolapse (Fig. 8.1).

Fig. 8.1Modified McCall culdoplasty : sutures goes through the vaginal apex including both the uterosacral ligaments and the peritoneum

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