A 60-year-old woman underwent total hysterectomy 5 years ago and now presents with stage IV vault prolapse containing a palpable enterocele. She desires the most durable definitive repair and is fit for major surgery. The gold standard procedure is:
- A Sacrospinous ligament fixation
- B Abdominal sacrocolpopexy ✓
- C Anterior colporrhaphy with McCall culdoplasty
- D Uterosacral ligament suspension
Correct answer: B. Abdominal sacrocolpopexy
Explanation
Abdominal sacrocolpopexy, attaching a mesh bridge between the vaginal apex and the sacral promontory, gives the lowest recurrence rates and the best preservation of vaginal length for apical or vault prolapse, and is regarded as the gold standard in a fit woman. Sacrospinous ligament fixation is the main vaginal alternative but shortens the vagina and produces a posterior axis deviation. McCall culdoplasty addresses a mild enterocele during vaginal repair and is inadequate alone for stage IV vault prolapse.
Reference: Berek and Novak's Gynecology, 16th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.