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n Obstetrics and Gynaecology Forum - Surgical options for uterine prolapse : something old and something new : review
A broad range of surgical options are now available for women presenting with uterine prolapse. A vaginal hysterectomy coupled with a robust vault support procedure remains an excellent choice in dealing with uterine prolapse. The importance of ensuring adequate fixation of the vault after hysterectomy cannot be overemphasized. The two best procedures for cuff support are sacrospinous fixation and high uterosacral ligament suspension. The latter can also be used for vault support following vaginal hysterectomy for uterine prolapse.
Retaining the prolapsed uterus and performing a hysteropexy operation has recently become a very popular surgical technique. This usually involves attaching uterine support sutures to either the sacrospinous or uterosacral ligaments without doing a hysterectomy. Vaginal mesh procedures are available for women with uterine prolapse. If a mesh is used, it is important to use a device that offers adequate apical support and the newer single incision sacrospinous support mesh kits may be superior.
The Le Fort colpopcleisis remains an excellent surgical procedure in the old and frail patient who has no desire to retain her potential for sexual activity. This is a minimally invasive operation with a significantly reduced risk of morbidity compared with more extensive procedures. The Manchester repair may now be re-emerging as treatment for uterine prolapse. The abdominal approach to uterine prolapse has recently become popular. This usually involves either a total or supracervical hysterectomy followed by sacrocolpopexy.
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