HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Kearney, R. Articles by DeLancey, J. O. L. Search for Related Content PubMed PubMed Citation Articles by Kearney, R. Articles by DeLancey, J. O. L.

Selecting Suspension Points and Excising the Vagina During Michigan Four-Wall Sacrospinous Suspension

From the Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan.

Address reprint requests to: John O. L. DeLancey, MD, University of Michigan, Department of Obstetrics and Gynecology, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0276; E-mail: delancey{at}med.umich.edu.

OBJECTIVE: To describe the variations in the location of the vaginal apex and the length of vagina excised in women undergoing the Michigan four-wall sacrospinous suspension for posthysterectomy vaginal vault prolapse.

METHODS: A prospective observational study of 76 women who had the Michigan modification sacrospinous suspension performed between 1998 and 2001 for posthysterectomy vaginal vault prolapse was carried out. Demographics and preoperative, operative, and postoperative findings were noted, including the pelvic organ prolapse quantification score. The locations of the suspension points relative to the hysterectomy scar were recorded. The amount of vagina excised at surgery and the pre- and postoperative vaginal lengths are reported.

RESULTS: The mean length and standard deviation of vagina excised was 4.6 ± 2.5 cm. The apex created at sacrospinous fixation was at the hysterectomy scar in only seven women (9%). It was most often situated behind the hysterectomy scar, in 58 cases (76%); it was situated in front of it in 11 (14%). In seven women no vagina was excised, and in the remaining 69 women a mean length of 5.1 ± 2.2 cm was removed. The mean vaginal lengths were 9.7 ± 1.7 cm preoperatively and 9.4 cm ± 0.8 postoperatively, a 0.3-cm difference.

CONCLUSION: When one performs the Michigan modification sacrospinous suspension, the chosen suspension points are often not at the hysterectomy scar, and in women with large prolapses excess vagina frequently is excised without compromising postoperative vaginal length.