For prophylaxis of enterocele and of prolapse of the vagina following hysterectomy, the vaginal stump is fixed in at-risk patients to the sacro-uterine ligaments (known as McCall's suture) or to the sacro-spinal ligament (Amreich-Richter method). We report on the indications and results obtained in 101 sacro-spinal fixations and 211 McCall sutures in vaginal hysterectomy and 118 McCall sutures in abdominal hysterectomy. From 1975 to 1981 sacro-spinal fixation was only occasionally employed in prophylaxis of enterocele. After introduction of the McCall suture in 1982, the use of this method has been steadily increasing and has largely replaced sacrospinal fixation for prophylactic purposes. Nevertheless we are still using this often in cases of total prolapse, since in that situation, the fixation of the vaginal stump to the sacrouterine ligaments (in most cases weakly developed) is insufficient and does not offer enough support. Of a total of 350 McCall sutures performed to date, postrenal anuria occurred twice after kinking of the ureters, a typical complication that requires removal of the McCall suture. In a total of 174 sacro-spinal fixations of the vaginal stump for prophylactic or therapeutic indications, pronounced intraoperative haemorrhage took place in about 5% of the cases, whereas in one case, there was an abscess formation due to an infected haematoma. Technical details on both methods and on avoiding complications are discussed.
Female Humans