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.
Vaginal procedures are McCall culdoplasty
, high uterosacral ligament suspension, iliococcygeus fascia suspension, Sacrospinous ligament fixation.
Additional procedures, including vaginal hysterectomy, McCall's culdoplasty
, sacrospinous colpopexy and sacrospinous cervicopexy, were carried out wherever appropriate.
Only 46% reported performing cystoscopy after doing a uterosacral ligament suspension; 29%, after McCall's culdoplasty
; and 34%, after an anterior repair.
: The standard for women without prolapse at hysterectomy
These include the vaginal procedures McCall culdoplasty
; plication of the uterosacral ligament; sacrospinous or prespinous fixation for vaginal vault prolapse; and Sacrocolpopexy (performed via an open procedure or laparoscopically).
The incidence of ureteral obstruction in this study was highest among those patients who underwent uterosacral ligament vaginal vault suspension (5.9%), and lowest among those who underwent distal McCall's culdoplasty
(0.5%) or anterior colporrhaphy (0.4%), he noted at the meeting.
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
Uterosacral vaginal vault suspension was associated with a higher rate of ureteral obstruction (5.9%) than other procedures used in the series, including proximal McCall's culdoplasty
(4.4%), distal McCall's culdoplasty
(0.5%), and anterior repair (0.4%), Dr.
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.
-- Prevention is the best medicine when it comes to enterocele formation, so consider performing a McCall's culdoplasty
in all patients undergoing vaginal hysterectomy, G.
In addition, consider performing prophylactic McCall's culdoplasty
or uterosacral cuff suspension at the time of all hysterectomies, by all routes--even in the absence of prolapse.