Outcomes

Few data exist regarding long-term outcomes after vaginal enterocele repair. In a study of 48 women who had McCall culdoplasty for large enterocele, procidentia, or complete vaginal vault eversion, only two enteroceles (4%) recurred 2 to 22 years (average, 7 years) postoperatively.9 Colombo and Milani10 found a similar rate of recurrence, with 3 of 62 (5%) patients experiencing vault prolapse recurrence 4 to 9 years after McCall culdoplasty. However, these studies were performed with various modifications of the McCall culdoplasty, and no comparison of the varying techniques has been made.

McCall culdoplasty has been implicated as a cause of ureteral obstruction. Given9 reported ureteral injury in 4%

Table 8-4.1. Complications after McCall culdoplasty*

Complication

Percent of Patients (n = 48)

Removal of silk suture

10

Postoperative cuff infection

4

High rectocele

4

Partial prolapse of vaginal vault

4

Shortened vagina

4

Introital stenosis

2

Pulmonary emboli

2

Nerve palsy

2

Ureteral obstruction

2

Reprinted from Given FT."Posterior culdeplasty": revisited.Am J Obstet Gynecol.1985 15;153(2):135-9,copyright 1985,with permission from Elsevier.

of McCall culdoplasty procedures. Stanhope et al.11 also found that culdoplasty increased the risk of ureteral obstruction after vaginal surgery. Some of the reported complications of McCall culdoplasty are listed in Table 8-4.1.Because of the small but significant ureteral injury rate, we advocate cystoscopy after all vaginal reconstructive procedures to rule out bladder pathology and to document ureteral patency.

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