Dear Dr Rashmi

i suppose the best way is to close the vaginal stump with mesh via intraperitoneal approach.

good luck

If you mean that the patient has vaginal vault prolapse with bowel behind after hysterectomy.

The correction of vaginal prolapse and return of the vagina to its original position the prolapse with the behind bowel will disappear

This can done through direct sacro-colpopexy = suspension of the vaginal valut to the anterior longitudinal ligament of the promontory of the sacrum through artificial tape to create an artificial ligament similar to the uterosacral ligament which maintains the uterus and vagina in the proper position.

Regards

Dear Ibrahim,

Direct sacro-colpopexy is going to correct vault prolapse. According to me, it is not going to correct protrusion of bowel completely.

Thank you for your answers everyone. Ibrahim you have explain the problem perfectly. Sacro-colpopexy has been offered to patient.

Veena- I am interested to know why this would not correct bowel protrusion?

Habibolla- is peritoneal approach more invasive and successful over sacro-colpopexy?

Best wishes

Rashmi

Dear Rashmi,

What I understand by bowel protrusion is vault prolapse and upper part of posterior vaginal wall prolapse (enterocele). Sacro colpopexy would lift up the vault up towards sacral promontory but is not likely to address prolapse of posterior vaginal wall completely. It will depend on how much bowel protrusion is there.  

Dear Dr Rashim

i my opinion, although trans peritoneal approach is more aggressive but it is more durable and secure.

Best Wishes

Habib

You should perform MR defecography before deciding th optimal surgical approach

Thanks for providing insight and consider other options prior to considering sacral colpopexy.

Best

Rashmi

Dear Vittorio,

How will MR defecography help in deciding about surgical approach?

simply by depicting at best the exact anatomy underlying the functional disorder, in singular cases