Various techniques have been described for the repair of vaginal vault prolapse after hysterectomy. Because of inherent difficulties associated with the sacrospinous fixation, a new repair, the levator myorraphy, was devised to simplify reconstruction of the pelvic floor 10 years ago. This repair results in a restored vaginal axis and prevention of posterior enterocele recurrence by recreating the levator shelf high within the peritoneal cavity and fixing the vault in that position. Because this procedure can be performed from a vaginal approach, morbidity is minimized. Over this 10-year time period, we have performed the levator myorraphy in over 120 women. We believe this approach can be easily taught, is highly effective, and results in a repair that most closely restores the normal anatomic position. Copyright (C) 2000 Elsevier Science Inc.
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