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International Urogynecology Journal
Published in: International Urogynecology Journal 11/2018

01-11-2018 | IUJ Video

Transvaginal native-tissue repair of enterocele

Authors: Rodolfo Milani, Stefano Manodoro, Alice Cola, Stefania Palmieri, Claudio Reato, Matteo Frigerio

Published in: International Urogynecology Journal | Issue 11/2018

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Abstract

Introduction and hypothesis

Enterocele repair represents a challenge for pelvic surgeons. Surgical management implies enterocele sac removal. Subsequently, hernial port closure and adequate suspension may be achieved with Shull uterosacral ligament suspension (ULS).

Methods

A 55-year-old woman with symptomatic stage 3 enterocele was admitted for transvaginal uterosacral ligaments suspension according to the described technique.

Results

Surgical procedure was successfully achieved without complications. Final examination revealed excellent pelvic supports and preservation of vaginal length. This step-by-step video tutorial may represent an important tool to improve surgical know-how.

Conclusions

Transvaginal uterosacral ligaments suspension provides a safe and effective technique for enterocele repair without the use of prosthetic materials. Identifying uterosacral ligaments, proper suture placement, and reapproximation of pubocervical and rectovaginal fascias with closure of the hernial port are the key points to achieve surgical success.
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Literature
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Carter JE. Enterocele repair and vaginal vault suspension. Curr Opin Obstet Gynecol. 2000;12(4):321–30.CrossRef
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Spelzini F, Frigerio M, Manodoro S, Interdonato ML, Cesana MC, Verri D, et al. Modified McCall culdoplasty versus Shull suspension in pelvic prolapse primary repair: a retrospective study. Int Urogynecol J. 2017;28(1):65–71.CrossRef
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Milani R, Frigerio M, Vellucci FL, Palmieri S, Spelzini F, Manodoro S. Transvaginal native-tissue repair of vaginal vault prolapse. Minerva Ginecol. 2018. (in press)
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Milani R, Frigerio M, Spelzini F, Manodoro S. Transvaginal uterosacral ligament hysteropexy: a video tutorial. Int Urogynecol J. 2017;28(5):789–91.CrossRef
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Milani R, Frigerio M, Manodoro S, Cola A, Spelzini F. Transvaginal uterosacral ligament hysteropexy: a retrospective feasibility study. Int Urogynecol J. 2017;28(1):73–6.CrossRef
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Karram M, Goldwasser S, Kleeman S, Steele A, Vassallo B, Walsh P. High uterosacral vaginal vault suspension with fascial reconstruction for vaginal repair of enterocele and vaginal vault prolapse. Am J Obstet Gynecol. 2001;185(6):1339–42. discussion 1342-3.CrossRef
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Manodoro S, Frigerio M, Milani R, Spelzini F. Tips and tricks for uterosacral ligament suspension: how to avoid ureteral injury. Int Urogynecol J. 2018;29(1):161–3.CrossRef
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Kasturi S, Bentley-Taylor M, Woodman PJ, Terry CL, Hale DS. High uterosacral ligament vaginal vault suspension: comparison of absorbable vs. permanent suture for apical fixation. Int Urogynecol J. 2012;23(7):941–5.CrossRef
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Chung CP, Miskimins R, Kuehl TJ, Yandell PM, Shull BL. Permanent suture used in uterosacral ligament suspension offers better anatomical support than delayed absorbable suture. Int Urogynecol J. 2012;23(2):223–7.CrossRef
Metadata
Title
Transvaginal native-tissue repair of enterocele
Authors
Rodolfo Milani
Stefano Manodoro
Alice Cola
Stefania Palmieri
Claudio Reato
Matteo Frigerio
Publication date
01-11-2018
Publisher
Springer London
Published in
International Urogynecology Journal / Issue 11/2018
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI
https://doi.org/10.1007/s00192-018-3686-3

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