Anatomic prerequisites of the surgical therapy of vaginal prolapse after hysterectomy.

Abstract

The prolapse of vaginal stub occurs in about 4% of hysterectomised patients. Suspension of vaginal stub on the ligamentum sacrospinale dextrum is an effective method of the surgical management. The vaginal approach puts increased demands on handiness and orientation in the operation field. Using a proper operation technique and perfect knowledge of the anatomic situation in fossa ischiorectalis can minimize the increased risk of bleeding during the fixation, which results from frequent and varied anastomoses of pelvic vessels. The authors measured several parameters on the group of pelvic girdles of 32 females and found following results: the distance between the base and the apex of spina ischiadica (17.1 mm); the distance between spina ischiadica and the lateral margin of the os sacrum in the axis of central fibres of ligamentum sacrospinale (29.8 mm); the length of axial fibres of ligamentum sacrospinale (37.2 mm); the longest (11.2 mm) and the shortest (1.3 mm) diameter of 15 mm from the top of spina ischiadica. In this site the thickness of muscular layer of musculus coccygeus (3.2 mm) has also been measured. The anatomic study can facilitate the introduction and implementation of more complex surgical techniques.