High Uterosacral Ligament Suspension With Fascial Reconstruction: Abdominal Approach
This repair is based on the concept that the uterosacral ligaments do not attenuate in cases of uterovaginal prolapse or posthysterectomy vaginal vault prolapse but instead break at certain points. The remnants of the uterosacral ligaments or the most distal ends are identified and tagged. The remnants are usually found in the vicinity of the ischial spines on each side (Fig. 42–1).
The ureters are identified on each side, and the enterocele is addressed by excision of the sac or by abdominal obliteration of the cul-de-sac. Three or four permanent sutures then are placed to plicate the ends of the uterosacral ligaments across to the midline. This creates a durable ridge to which the vaginal vault can be attached (see Fig. 42–1
