Abdominal hysterectomy with or without angle stitch: correlation with subsequent vaginal vault prolapse.

OBJECTIVE

The objective of the study was to assess whether cardinal-uterosacral ligament lateral vaginal cuff angle stitches at the time of total hysterectomy may assist in preventing subsequent apical vault prolapse.

STUDY

DESIGN

Total hysterectomies without cuff angle stitches were performed in 7 unembalmed cadavers. Successive hanging weights of 1, 2, 3, and 4 kg were loaded against the vaginal cuff and distances moved were recorded. The same process was repeated after tying bilateral angle stitches.

RESULTS

Average distances pulled with 1, 2, 3, and 4 kg of traction against the cuff without angle stitches were 14.6 +/- 1.4, 19.1 +/- 1.7, 23.1 +/- 2.3, and 27.6 +/- 2.0 mm, respectively. After completing angle sutures, these distances were 13.1 +/-1.1, 17.3 +/- 1.5, 20.9 +/- 1.9, and 25.1 +/- 2.6 mm, respectively (P = .026).

CONCLUSION

Methodical incorporation of the cardinal-uterosacral ligaments into the vaginal cuff margins at time of total abdominal hysterectomy may help minimize subsequent apical vault prolapse.