ICS 1999, Denver
Video presentations
Laparoscopic approach to enterocele repair and vaginal vault suspension

JR Miklos MD and N Kohli MD
Northside Hospital, Atlanta, U.S.A. and Good Samaritan Hospital, Cincinnati, U.S.A.

Aims of Study: To present a video of a laparoscopic approach to enterocele and vaginal apex/vault suspension utilizing a site specific defect repair approach to the endopelvic fascia. (1).

Methods: Open laparoscopy is performed at the infraumbilical site. Three other access ports are placed under direct visualization. The enterocele is elevated and identified, the peritoneum and vaginal epithelium excised. The enterocele is repaired by securing the apical edges of pubocervical to rectovaginal septum. The vault is supported by suturing the vaginal apex to the uterosacral ligaments bilaterally utilizing nonabsorbable suture. Cytoscopy is performed to assure no breech of bladder or ureter integrity.

Results: We have performed over 50 laparoscopic enterocele and vaginal vault suspension without a major complication. We routinely perform the procedure in less than 120 minutes and find that it can be performed concomitantly with other laparoscopic extirpative and reconstructive surgical procedures.

Conclusions: Enterocele repair and vaginal vault suspension through a fascial defect repair is easily performed utilizing a laparoscopic approach.

(1) Site specific fascial defects in the diagnosis and surgical management of enterocele. Am J Obstet Gynecol 1998;179:1418-23.

Source: 29 th International Continence Society Annual Meeting, August 22-26, 1999, Video Demonstration