This document summarizes guidelines for managing vaginal vault prolapse after hysterectomy. It discusses prevention techniques during hysterectomy like McCall culdoplasty and ligament fixation. Assessment involves the POPQ system. Conservative options include pessaries but have unclear roles. Surgical options include sacrospinous fixation, sacrocolpopexy, and colpocleisis for frail patients. Sacrospinous fixation has shorter recovery but higher recurrence risks than sacrocolpopexy. Laparoscopic techniques require more skill but have shorter recovery. Slings and mesh reconstruction require further research.

1. Management of Vault prolapse Based on RCOG guide lines Dr.V.Ravimohan www.mrcogexam.net

20. more sexual dysfunction more intraoperative blood loss longer catheter use, more urinary tract infection and more urinary incontinence . a lower rate of recurrence combined rate of apical and anterior vaginal wall prolapse was significantly higher posterior vaginal wall prolapse following abdominal sacrocolpopexy. higher cost slower return to normal activity operating time and hospital stay were shorter significantly longer operating time Sacrospinous fixation Sacroxcolpopexy

21. Cochrane review Sacrospinous fixation Sacroxcolpopexy cheaper Quicker return to normal activities a lower rate of recurrence Shorter operation time less dyspareunia

28. Sacrocolpopexy-Open Vs Laparoscopy requires skill, training and longer operating time, although operating time shortens with greater experience. shorter stay reduced postoperative morbidity less scarring an enhanced view of the pelvis, which facilitates a more anatomical repair laparoscopy open