Comparison of Techniques for Transvaginal and Retropubic Repair of Paravaginal Wall Defects in the Cadaveric Model

摘要

Objective: Surgical repairs of a paravaginal defect using both transvaginal and retropubic approaches have been described. The authors compare suture position of the two approaches in a cadaveric model.Methods: Two adult female cadavers with evidence of bilateral paravaginal defects on physical examination were selected. Paravaginal defect repairs, both transvaginal and retropubic, were completed by one surgeon on each cadaver. The surgeon was blinded to suture position of each technique.Results: Both transvaginal and retropubic paravaginal repairs were able to reduce the paravaginal defect. The retropubic approach allows more uniform suture approximation with incorporation of the ischial periosteum and iliococcygeus fascia. The transvaginal approach allows excellent suture position in the midtendinous arc, but it does not achieve the proximal to distal width of suture placement that is achieved through the retropubic approach. There was no incorporation or violation of the internal iliac vessels, pudendal vessels, or obturator nerve with either approach.Conclusion: Paravaginal repair may be performed both transvaginally and retropubically. The retropubic approach allows more proximal placement of sutures and has better incorporation of tissues in the ischial periosteum and iliococcygeus fascia than the transvaginal approach.