ABSTRACT
This chapter focuses on the open abdominal techniques used to treat apical prolapse at the time of a hysterectomy in the post-hysterectomy patient and in the patient with uterine descent wishing to preserve her uterus. It is performed in the post-hysterectomy patient and involves attaching the vaginal apex to the sacrum with the use of an intervening graft. The initial suture is placed at the base of the cul-de-sac followed by three or four sutures that, once tied in a purse-string fashion, will obliterate the cul-de-sac in theory to help prevent small bowel entrapment or enterocele recurrence as well as support the vaginal apex. A 2018 meta-analysis of uterine preservation compared to hysterectomy in pelvic organ prolapse surgery found that compared to hysterectomy plus mesh sacrocolpopexy, uterine preservation with sacrohysteropexy reduces ME, operative time, blood loss, and surgical cost without differences in prolapse recurrence.
