Enterocele repair and vaginal vault suspension

A paradigm shift has occurred in the approach to enterocele repair and vagi nal vault suspension, This change in our approach is based on anatomic diss ections that demonstrate that the loss of the upper suspensory fibers of th e paracolpium and parametrium lead to uterine prolapse and vaginal prolapse after hysterectomy. In addition, the separation of the pubocervical from t he rectovaginal fascia results in apical enterocele where the peritoneum is in contact with the vaginal mucosa, These fascial defects are hernias, and appropriate herniorraphy techniques will correct these defects and result in successful reconstruction of the vaginal tube and its reattachment to th e suspensory cardinal uterosacral complex, (C) 2000 Lippincott Williams & W ilkins.