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Surgical anatomy of the vaginal vault

AIM: Vaginal vault (VV) surgery should be a key part of surgery for a majority of pelvic organ prolapse (POP). The surgical anatomy of the VV, the upper most part of the vagina, has not been recently subject to a dedicated examination and description. METHODS: Cadaver studies were performed in (i) 1...

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Autores principales: Haylen, Bernard T., Vu, Dzung
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9543804/
https://www.ncbi.nlm.nih.gov/pubmed/35620982
http://dx.doi.org/10.1002/nau.24963
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author Haylen, Bernard T.
Vu, Dzung
author_facet Haylen, Bernard T.
Vu, Dzung
author_sort Haylen, Bernard T.
collection PubMed
description AIM: Vaginal vault (VV) surgery should be a key part of surgery for a majority of pelvic organ prolapse (POP). The surgical anatomy of the VV, the upper most part of the vagina, has not been recently subject to a dedicated examination and description. METHODS: Cadaver studies were performed in (i) 10 unembalmed cadaveric pelves (observation); (ii) 2 unembalmed cadaveric pelves (dissection); (iii) 5 formalinized hemipelves (dissection). The structural outline and ligamentous supports of the VV were determined. Further confirmation of observations in post‐hysterectomy patients were from a separate study on 300 consecutive POP repairs, 46% of whom had undergone prior hysterectomy. RESULTS: The VV is equivalent to the Level I section of the vagina, measured posteriorly from the top of the posterior vaginal wall (apex or highest part of the vagina) to 2.5 cm below this point. It comprises the anterior fornix (through which cervix protrudes or is removed at hysterectomy), posterior fornix and two lateral fornices. Before hysterectomy, the posterior aspects of the cervix and upper vagina are supported by the uterosacral (USL) and cardinal ligaments (CL), the distal segments of which fuse together to form a cardinal‐uterosacral ligament complex (cardinal utero‐sacral complex), around 2–3 cm long. Post‐‐‐hysterectomy, there is some residual USL support to the anterior fornix but the posterior fornix has no ligamentous support and is thus more vulnerable to prolapse. CONCLUSION: Effective management of VV prolapse will need to be part of most POP repairs. Enhanced understanding of the surgical anatomy of the vaginal vault allows more effective planning of those POP surgeries.
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spelling pubmed-95438042022-10-14 Surgical anatomy of the vaginal vault Haylen, Bernard T. Vu, Dzung Neurourol Urodyn Reviews AIM: Vaginal vault (VV) surgery should be a key part of surgery for a majority of pelvic organ prolapse (POP). The surgical anatomy of the VV, the upper most part of the vagina, has not been recently subject to a dedicated examination and description. METHODS: Cadaver studies were performed in (i) 10 unembalmed cadaveric pelves (observation); (ii) 2 unembalmed cadaveric pelves (dissection); (iii) 5 formalinized hemipelves (dissection). The structural outline and ligamentous supports of the VV were determined. Further confirmation of observations in post‐hysterectomy patients were from a separate study on 300 consecutive POP repairs, 46% of whom had undergone prior hysterectomy. RESULTS: The VV is equivalent to the Level I section of the vagina, measured posteriorly from the top of the posterior vaginal wall (apex or highest part of the vagina) to 2.5 cm below this point. It comprises the anterior fornix (through which cervix protrudes or is removed at hysterectomy), posterior fornix and two lateral fornices. Before hysterectomy, the posterior aspects of the cervix and upper vagina are supported by the uterosacral (USL) and cardinal ligaments (CL), the distal segments of which fuse together to form a cardinal‐uterosacral ligament complex (cardinal utero‐sacral complex), around 2–3 cm long. Post‐‐‐hysterectomy, there is some residual USL support to the anterior fornix but the posterior fornix has no ligamentous support and is thus more vulnerable to prolapse. CONCLUSION: Effective management of VV prolapse will need to be part of most POP repairs. Enhanced understanding of the surgical anatomy of the vaginal vault allows more effective planning of those POP surgeries. John Wiley and Sons Inc. 2022-05-27 2022-08 /pmc/articles/PMC9543804/ /pubmed/35620982 http://dx.doi.org/10.1002/nau.24963 Text en © 2022 The Authors. Neurourology and Urodynamics published by Wiley Periodicals LLC. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Reviews
Haylen, Bernard T.
Vu, Dzung
Surgical anatomy of the vaginal vault
title Surgical anatomy of the vaginal vault
title_full Surgical anatomy of the vaginal vault
title_fullStr Surgical anatomy of the vaginal vault
title_full_unstemmed Surgical anatomy of the vaginal vault
title_short Surgical anatomy of the vaginal vault
title_sort surgical anatomy of the vaginal vault
topic Reviews
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9543804/
https://www.ncbi.nlm.nih.gov/pubmed/35620982
http://dx.doi.org/10.1002/nau.24963
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