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Laparoscopic And Minimally Invasive Procedures continued
Enterocele Repair
Enterocele formation, which can be reversed through enterocel repair, usually occurs in women who have had a hysterectomy. Most reconstructive surgeons believe this is, in part, due to the removal of the uterus. To understand an enterocele repair, one must first understand the anatomy of this defect. An enterocele is defined as peritoneum (skin on the inside of the abdominal cavity) in direct contact with vaginal epithelium (skin of the vagina) with no intervening fascia (support structure). To repair the enterocele, the supportive structure must be reconstructed. The support structure at the apex of the vagina is the pubocervical fascia (anterior vaginal wall) and the rectovaginal fascia (posterior vaginal wall). The apex of both vaginal walls usually fuses into the uterus. However, in patients where the uterus has been removed through a hysterectomy, sometimes the supportive layers of the anterior an! d posterior walls have not fused or scarred together, leaving an area lacking support. Therefore a herniation at the apex of vagina allows the peritoneum to come in direct contact with vaginal skin and create a bulge.
Enterocele repair involves suturing the apex of pubocervical and rectovagina fascia back together. These sutures will only repair the apical defect; it will not support the apex of the vagina to a supporting structure. Usually patients receiving an enterocele repair also require a vaginal apex suspension (vaginal vault suspension).
Enterocele Repair Figure: 1 |
Enterocele Repair Figure: 2 |
Enterocele Definition - defect in the pubocervical fascia and rectovaginal fascia. The second picture shows the elevation of the defect into the abdominal cavity.
Enterocele Repair Figure: 3 |
Enterocele Sac Resection - The skin, thus the enterocele, has been removed so one can identify the edges of the supportive layers of the vagina. Those supportive layers are the pubocervical and rectovaginal fascia. |
Enterocele Repair Figure: 4 |
Enterocele repair -The pubocervical and rectovaginal fascia (supportive layers) are sewn together, repairing the vaginal hernia known as an enterocele. However, enterocele surgery has not addressed supporting the vagina apex ... most patients who have done an enterocele repair also need a vaginal vault suspension (please see the Vaginal Vault Suspension section) |
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