Module 13: Vaginal Correction of Anterior and Posterior Vaginal Wall Prolapse with and Without Vaginal Hysterectomy
This module begins with an overview of the concepts of pelvic support, as well as an anatomic review utilizing cadaveric dissection of normal anterior and posterior vaginal wall support. A traditional cystocele repair with Kelly plication, as well as numerous examples of vaginal paravaginal repair are demonstrated. Surgical techniques to appropriately determine midline versus paravaginal defects are demonstrated and discussed. Defect-specific rectocele repair, perineorrhaphy and levatorplasty are all demonstrated. A section on combined repairs demonstrates procedures in conjunction with vaginal hysterectomy and enterocele repair. Augmented mesh repairs of the anterior and posterior vaginal walls are also demonstrated with a detailed discussion of indications and fixation points when mesh is utilized. The final chapter addresses commonly asked questions.