Surgical Repair Techniques

Surgical repair of enterocele can be performed vaginally, abdominally, or laparoscopically, but few data exist comparing the various repair techniques. The approach and type of procedure performed depend on the surgeon's preference and presence or absence of concomitant vaginal or abdominal pathology. We will focus on vaginal repair techniques.

Traditional vaginal enterocele repair entails isolation of the enterocele sac, careful exploration of its contents, and closure with multiple circumferential, nonabsorbable, pursestring sutures incorporating the cardinal-uterosacral ligaments.2 At our institution, this technique is used in combination with sacrospinous ligament fixation, ileococ-cygeus vault suspension, or extraperitoneal uterosacral ligament vaginal vault suspension when cul-de-sac obliteration or adhesions are present and the uterosacral ligaments are not accessible. Additional enterocele repair techniques include McCall-type culdoplasty, and more recently, uterosacral ligament vaginal vault suspension with fascial reconstruction. Whereas the latter two techniques are our preferred methods of enterocele repair, uterosacral ligament vaginal vault suspension has been described elsewhere. We will therefore present our techniques for traditional vaginal enterocele repair and McCall-type culdoplasty.

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