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How much dose the vaginal lenght affect your destion?
Moderator(s): Amy Cassini
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12/19/2014 at 3:28:33 AM GMT
Posts: 36
How much dose the vaginal lenght affect your destion?

How much dose the vaginal lenght affect your destion?
by Abdulah Al-Tayyem


12/23/2014 at 7:19:07 PM GMT
Posts: 0
The vaginal lenght doesn't affect the decision of LSC
The decisions are influenced by the BMI and the intraperitoneal adherences

B DEVAL


1/8/2015 at 2:10:32 PM GMT
Posts: 7
If the patient has a very short vagina, a sacrocolpopexy will be a better a option - especially with post-operative sexual function.


1/9/2015 at 6:35:12 PM GMT
Posts: 9
Vaginal length does not really affect dissection....unless the vaginal length is extra long, ie greater than 10.5 or 11 cm, and in that case most likely the patient has an enterocele present apically and this must be addressed by placating the extra tissue (ie length) which can be done with interrupted 2-0 vicryl sutures horizontally, ie from the posterior apical rectovaginal septum to the apical portion of the pubocervical fascia. Alternatively the enterocele could be excised, however then you have to close the cuff and you then run the same risks of mesh extrusion as with TLH. We usually choose to just plicate and try to avoid excision. If you don't reduce the enterocele, the vaginal tissue can reach the sacrum by itself and therefore the mesh will NOT be placed down far enough on the vagina and it will only be on the enterocele and this will lead to higher rate of failure. Once the enterocele is reduced, the dissection can then be taken further down the anterior wall and the posterior wall, far enough to reach the good anterior and posterior fascia and therefore have a proper placement of the mesh. One must be careful if the vagina is too short, ie less than 7cm as once you place mesh over the apex there is no chance to elongate it and you will be stuck with that length...you may be able to gain a cm with sacralcolpopexy but with less than 7cm of vagina that may not be enough and you will then be stuck with a short vagina with mesh on the apex....very difficult to gain any length after that!


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