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.
The abdominal sacral colpopexy offers the following advantages, consistent anatomy, most definitive enterocele repair and culdoplasty
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.
In our study all women who had undergone vaginal hysterectomy, also had McCall culdoplasty
9%), and lowest among those who underwent distal McCall's culdoplasty
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
9%) than other procedures used in the series, including proximal McCall's 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.
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.