It is difficult to know what CPT code to use for billing when my practice's physicians do a McCall culdoplasty during a vaginal or laparoscopic hysterectomy.
The McCall culdoplasty procedure is performed to support the vaginal cuff at the time of a vaginal hysterectomy by attaching the uterosacral and cardinal ligaments to the peritoneal surface with suture material such that, when tied, it draws toward the midline, helping to close off the cul-de-sac.
Vaginal procedures are McCall culdoplasty
, high uterosacral ligament suspension, iliococcygeus fascia suspension, Sacrospinous ligament fixation.
A McCall culdoplasty
or other similar procedure would not be feasible if the cervix is left in situ.
The McCall culdoplasty is the most commonly performed technique for prevention of prolapse at the time of vaginal hysterectomy; it also may be performed from an abdominal approach.
16) The investigators found a significantly lower incidence of stage 2 pelvic organ prolapse (descent to within 1 cm of the hymen) at 3 years after hysterectomy for McCall culdoplasty (2/32 [6%]) versus peritoneal closure (13/33 [39%]) and vaginal Moschowitz procedure (10/33 [30%]) (P = .
In our study all women who had undergone vaginal hysterectomy, also had McCall culdoplasty done.
Sacrospinous ligament fixation and modified McCall culdoplasty during vaginal hysterectomy for advanced uterovaginal prolapse.
I developed what I call a "babylap" that is one-third the size of a regular laparotomy that can be used to push the bowel and other organs away to gain better visualization while removing the ovaries and performing a McCall culdoplasty
The concept of utilizing the uterosacral ligaments to support the vaginal cuff and correct an enterocele is nothing new: As early as 1957, Milton McCall described what became known as the McCall culdoplasty
, in which sutures incorporated the uterosacral ligaments into the posterior vaginal vault to obliterate the cul-de-sac and suspend or support the vaginal apex at the time of vaginal hysterectomy.
In this article, I describe a technique to reduce the risk of these defects after vaginal hysterectomy: high uterosacral suspension, or modified McCall culdoplasty
Q I performed a McCall culdoplasty
following vaginal hysterectomy, but the insurance company denied payment for the culdoplasty, stating that this procedure is included in the hysterectomy.