Abdominal hysterectomy with or without angle stitch: correlation with subsequent vaginal vault prolapse

Objective: The objective of the study was to assess whether cardinal-uterosacral ligament lateral vaginal cuff angle stitches at the time of total hysterectomy may assist in preventing subsequent apical vault prolapse. Study Design: Total hysterectomies without cuff angle stitches were performed in 7 unembalmed cadavers. Successive hanging weights of 1, 2, 3, and 4 kg were loaded against the vaginal cuff and distances moved were recorded. The same process was repeated after tying bilateral angle stitches. Results: Average distances pulled with 1, 2, 3, and 4 kg of traction against the cuff without angle stitches were 14.6 ± 1.4, 19.1 ± 1.7, 23.1 ± 2.3, and 27.6 ± 2.0 mm, respectively. After completing angle sutures, these distances were 13.1 ±1.1, 17.3 ± 1.5, 20.9 ± 1.9, and 25.1 ± 2.6 mm, respectively (P = .026). Conclusion: Methodical incorporation of the cardinal-uterosacral ligaments into the vaginal cuff margins at time of total abdominal hysterectomy may help minimize subsequent apical vault prolapse.