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Long-Term Experience with Modified McCall Culdoplasty in Women Undergoing Vaginal Hysterectomy for Pelvic Organ Prolapse

      ABSTRACT

      Objective

      The incidence of post-hysterectomy vault prolapse following native tissue repair has been reported to be as high as 43%. The optimal way to maintain vault support is unknown. Our aim was to evaluate the long-term efficacy of modified McCall culdoplasty during vaginal hysterectomy for symptomatic uterine prolapse in preventing the recurrence of vaginal vault prolapse.

      Methods

      We conducted a retrospective chart review involving 490 patients who underwent vaginal hysterectomy with modified McCall culdoplasty, with or without a concomitant stress incontinence procedure, between January 2008 and December 2018 at Mount Sinai Hospital in Toronto. Data analyzed included patient demographics, preoperative prolapse staging, intraoperative and postoperative complications, and postoperative subjective and objective success rates.

      Results

      A total of 490 patients underwent vaginal hysterectomy with modified McCall culdoplasty. The mean follow-up period was 2.8 years. The objective success rate of vault support was 97.1%, and the subjective success rate was 94.1%. The total rate of reoperation for recurrence of vault prolapse was 1.0%. The objective cystocele recurrence rate was 8.6%, and 2.4% of these cases required reoperation. The objective rectocele recurrence rate was 4.7%, with 1.2% requiring reoperation. Unilateral ureteric kinking requiring intraoperative release of the McCall suture was recorded for 2.9% of patients. Overall, there was significant improvement in urinary, bowel, and prolapse symptoms post procedure.

      Conclusion

      This cohort of patients who underwent modified McCall culdoplasty had low rates of vault prolapse recurrence and prolapse symptoms. The modified McCall culdoplasty technique practised at our institution is safe and effective in preventing post-hysterectomy vault prolapse.

      RÉSUMÉ

      Objectif

      L'incidence rapportée du prolapsus du dôme vaginal post-hystérectomie après la réparation avec des tissus autologues s’élève à 43 %. La méthode de support optimale du dôme vaginal demeure inconnue. L'objectif était d’évaluer l'efficacité à long terme de la culdoplastie de McCall modifiée réalisée pendant l'hystérectomie vaginale pour traiter le prolapsus utérin symptomatique dans la prévention du prolapsus du dôme vaginal récidivé.

      Méthodologie

      Nous avons effectué un examen rétrospectif des dossiers de 490 patientes ayant subi une hystérectomie vaginale avec culdoplastie de McCall modifiée, avec ou sans intervention pour traiter l'incontinence à l'effort concomitante, entre janvier 2008 et décembre 2018 au Mount Sinai Hospital à Toronto. Les données analysées comprenaient les caractéristiques démographiques des patientes, la stadification du prolapsus préopératoire, les complications peropératoires et postopératoires ainsi que les taux de réussite subjective et objective postopératoires.

      Résultats

      Au total, 490 patientes ont subi une hystérectomie vaginale avec culdoplastie de type McCall modifiée. La période moyenne de suivi était de 2,8 ans. Le taux de réussite objective du support du dôme vaginal était de 97,1 %, tandis que le taux de réussite subjective était de 94,1 %. Le taux de réopération pour le prolapsus du dôme vaginal récidivé était de 1,0 %. Le taux de récidive de cystocèle objective était de 8,6 %, et une réopération a été requise dans 2,4 % de ces cas. Le taux de récidive de rectocèle objective était de 4,7 %, et une réopération a été requise dans 1,2 % de ces cas. La plicature urétérale unilatérale nécessitant le lâchage peropératoire de la suture McCall a été consignée dans 2,9 % des cas. Dans l'ensemble, une amélioration significative des symptômes urinaires, intestinaux et du prolapsus a été observée après l'intervention.

      Conclusion

      Cette cohorte de patientes ayant subi une culdoplastie de McCall modifiée a présenté un faible taux de récidive et de symptômes du prolapsus du dôme vaginal. La culdoplastie de McCall modifiée pratiquée à notre établissement est sécuritaire et efficace pour prévenir le prolapsus du dôme vaginal post-hystérectomie.

      Keywords

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