POSTHYSTERECTOMY VAGINAL VAULT PROLAPSE - PRIMARY REPAIR IN 693 PATIENTS

Objective: To examine the results of primary repair of posthysterectom y vaginal vault prolapse in a current, large series of patients with l ong-term follow-up. Methods: From January 1976 to December 1987, 693 p atients underwent primary repair of vault prolapse at the Mayo Clinic. The Mayo culdoplasty technique was used in 95% of these patients. Pat ients were followed up by reference to their Mayo Clinic medical recor ds, a specifically designed questionnaire, and pelvic examination in a subgroup of patients. Results: The median age at operation was 66 yea rs. Abdominal hysterectomy had been performed on 49.5% of patients and vaginal hysterectomy on 43.4% (hysterectomy type was not documented o n 7.1%). The median number of years to vault prolapse repair after hys terectomy was 15.8 (range 0.4-48.4). Information about prolapse after primary repair was available for 504 patients (72.7%) and 80 had evide nce or complaint (bulge, protrusion) of recurrent prolapse. Thirty-six of 693 patients (5.2%) had subsequent prolapse repair. Eighty-two per cent of patients indicated satisfaction with the result. Complications of operation included entry into the bladder or rectum (2.3% of patie nts), vault hematoma (1.3%), cuff infection (0.6%), and ureteral compl ications (0.6%). The number of patients presenting for vault prolapse repair increased during the study interval. Conclusion: The Mayo culdo plasty fan be performed with minimal morbidity. It achieved an anatomi c restoration of upper vaginal support in a high percentage of patient s with long-term follow-up. (Obstet Gynecol 1998;92:281-5. (C) 1998 by The American College of Obstetricians and Gynecologists.).