Prophylactic mccall culdoplasty by a vaginal approach. Pdf anatomical and functional results of mccall culdoplasty in the. Bui, md, frequency and natural history of duplex detected stenosis femoropopliteal endovascular therapy. Read a description of the technique of mccall culdoplasty on. May be performed at time of vaginal hysterectomy or post hysterectomy. Surgical repairs for vaginal apical support kusmw wesley obgyn. Sacrospinous ligament fixation and modified mccall culdoplasty. Possible cause of failure after mccall culdoplasty article pdf available in archives of gynecology 2834. When the obgyn does this, he also repairs the enterocele mccall culdoplasty which you should not bill separately. Pdf anatomical and functional results of mccall culdoplasty. Western australian coding rule department of health. Apr 28, 2017 apical support is achieved by mccall culdoplasty and creating a new vaginal apex. Copyright 2020 international academy of pelvic surgery.
Common cpt codes for adult index proced ures cystoscopy 52000 cystourethroscopy 52005 cystourethroscopy with retrograde urography 52204 cystourethroscopy, with biopsy 52224 turbt lesions mccall culdoplasty means repair of enterocele and it is included in the hysterectomy procedure. Hill, pa many tim es, m ore than one surgical procedure is perform ed during the sam e encounter. Reich modification of the mccall culdoplasty to prevent andor repair prolapse during total laparoscopic hysterectomy. Mccalls culdoplasty has been recognised as a preventative measure during vaginal hysterectomy to prevent future vault prolapse. 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 culdesac. Report mccall s culdoplasty with 57435 published on wed dec 01, 2010 question. Understanding which m odifier to use is important for ensuring appropriate reimbursem ent. Each mccall suture is placed deeply into the left pararectal fascia then across the front of the sigmoid colon and deep into the right pararectal fascia.
Apical support is achieved by mccall culdoplasty and creating a new vaginal apex. Mayomccall culdoplasty elevation of vaginal apex to high uterosacral ligament proven efficacy in enterocele repair wide experience in specific centers reported high success rates usefulness in complete prolapse in question. Listing a study does not mean it has been evaluated by. Report mccalls culdoplasty with 57435 published on wed dec 01, 2010 question. Anatomical and functional results of mccall culdoplasty in. Pdf background studies have shown that vaginal vault prolapse can affect up to 43% of women following hysterectomy for pelvic organ prolapse. This is an excellent technique, as it reattaches the vaginal cuff to its support structures. A small randomised trial compared vaginal moschowitztype operation, mccalls culdoplasty and peritoneal closure of the culdesac as preventive measures against the development of enterocele.
A technique for modified mccall culdoplasty at the time of abdominal hysterectomy. Mccall culdoplasty at the time of vaginal hysterectomy is effective in. Urogynecology consultants surgical treatment options. Report 57425 laparoscopy, surgical, colpopexy suspension of vaginal apex only. The mccall culdoplasty closes the redundant culdesac and associated enterocele, provides apical support, and lengthens the vagina. Vaginal hysterectomy with mccall culdoplasty and bilateral salpingooophorectomy, pelvic floor repair c. Patients who underwent vaginal hysterectomy and cuff suspension for pelvic organ prolapse were retrospectively analyzed.
Sacrospinous ligament fixation after vaginal hysterectomy. Reader inquires about coding for mccall culdoplasty. Vaginal vault prolapse is a common complication following vaginal hysterectomy with negative impact on womens quality of life due to associated urinary, anorectal and sexual dysfunction. Total vaginal hysterectomy and mccall culdoplasty youtube. Gynecological surgery vaginal mccall culdoplasty versus laparoscopic uterosacral plication to prophylactically address vaginal vault prolapse kathy niblock 0 emily bailie 1 geoff mccracken 0 keith johnston 1 0 craigavon area hospital, 68 lurgan rd, portadown, craigavon, bt63 5qq, northern ireland 1 antrim area hospital, 45 bush rd, antrim bt41 2rl, northern ireland.
After the uterus is removed at the time of hysterectomy the uterosacral ligaments are identified and incorporated into the closure of the peritoneum and upper vagina using 12 sutures. There was a statistically significant difference in the duration of table 1 demographics for the uterosacral plication and the mccall culdoplasty patient groups usp mccalls p value mean age range 52. The answers for you be the coder and reader questions provided by melanie witt, rn, cpc, cobgc, ma. A clear understanding of the supporting mechanism for the uterus and vagina is important in making the right choice of corrective procedure. Mccall procedure, sutures penetrate the posterior vaginal wall the culdesac peritoneum remnants of the uterosacralcardinal complex fascial tissue lateral and posterior to the upper vagina and rectum fastdesac track modified mccall culdoplasty symmonds and colleagues described this approach to symptomatic vaginal vault prolapse. Mccall7 described the technique of surgical correction of enterocele and deep culdesac during vaginal hysterectomy. Clinical utility of routine duplex surveillance is questionable. Prophylactic modified mccall culdoplasty during total laparoscopic hysterectomy the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Pdf possible cause of failure after mccall culdoplasty. Bilateral high uterosacral ligament suspension compared with mccall culdoplasty for vaginal vault support at vaginal hysterectomy hypothesis aims of study to compare both anatomic and functional outcomes of patients undergoing high uterosacral ligament suspension husls or mccall culdoplasty at the time of vaginal. State of the art atlas and textbook of laparoscopic suturing. Pelvic floor muscle training pfmt has been proposed as a measure to prevent pelvic organ prolapse. The most commonly performed culdoplasties are the mccall, moschcowitz, and halban methods.
The external mccall stitch also incorporates the posterior vaginal apex. Anatomical and functional results of mccall culdoplasty in the prevention of enteroceles and vaginal vault prolapse after vaginal hysterectomy. Correctly communicating what you did is an important step in getting the claim paid in a timely manner. Vault prolapse, mccall culdoplasty, uterosacral plication. Sitespecific fascial defects in the diagnosis and surgical. Sacrospinous ligament fixation and modified mccall culdoplasty during vaginal hysterectomy for advanced uterovaginal prolapse. Mccall s culdoplasty another procedure for closing the space between the vagina and rectum and resuspending the top of the vagina through a vaginal incision. 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. After the mccall culdoplasty, we considered a vaginal vault at point c mccall culdoplasty and shull suspension. Mccall culdoplasty and sacrospinous fixation can be carried out at vaginal hysterectomy. Approaches to pelvic organ prolapse surgery workshop.
In gynecological surgery, one particular area of concern after hysterectomy is the risk of developing an enterocele or vaginal apical prolapse. Bilateral high uterosacral ligament suspension compared with mccall culdoplasty for vaginal vault support at vaginal hysterectomy hypothesis aims of study to compare both anatomic and functional outcomes of patients undergoing high uterosacral ligament suspension husls or mccall culdoplasty at the time of vaginal hysterectomy. Coding for multiple surgical procedures by emily h. Following vaginal hysterectomy, one to two internal mccall sutures are placed using a zero monofilament absorbable suture. The uterosacral and cardinal ligaments are reapproximated in the midline recreating central support to the vagina. The mean parity and bmi in both groups were comparable with p values of 0. Conventional and vaginal cystocoele and rectocoele repair f. Pdf the objective of the study is to evaluate the anatomical and functional results of the mccall culdoplasty in the treatment of moderate hysterocele.
Western australian coding rule 061001 mccall s culdoplasty q. Listing a study does not mean it has been evaluated by the u. It was first described by sederl cited in references 1 and 2 in 1958 and was originally developed for therapeutic purposes only, as a method of treating patients with posthysterectomy vaginal vault prolapse. Oct 27, 2019 the mccall culdoplasty closes the redundant culdesac and associated enterocele, provides apical support, and lengthens the vagina.
Mccall culdoplasty at the time of vaginal hysterectomy is a recommended measure to prevent enterocele formation. The only code for a mccall culdoplasty is for a vaginal route and as the procedure is laparoscopically performed, you should not report culdoplasty separately. Urogynaecology fellowship program national university of. The culdoplasty is to prevent prolapse in the future. Our surgeon usually performs a mccall s culdoplasty at the time of vaginal hysterectomy. Mccall culdoplasty definition of mccall culdoplasty by. Apr 25, 20 prophylactic modified mccall culdoplasty during total laparoscopic hysterectomy the safety and scientific validity of this study is the responsibility of the study sponsor and investigators.
Suturing the cardinal and uterosacral ligaments to the vaginal cuff at the time of abdominal or laparoscopic hysterectomy is effective in. Maggie vuturo, md, mccall culdoplasty to repair an unusual case of an enterocele 1. The late late show with james corden recommended for you. In icd10amachiacs eighth edition effective 1 july 20, a new alphabetic index entry was created for mccalls culdoplasty. Our aim was to compare the effectiveness, complications rate, and functional results of modified mccall culdoplasty and shull suspension. Prophylactic modified mccall culdoplasty during total. My obgyn performed a laparoscopic uterosacral plication and a high mccall s culdoplasty. The management of post hysterectomy vaginal vault prolapse. In this article, i describe a technique to re duce the risk of these defects after vaginal hysterectomy. The term mccall culdoplasty appears nowhere in the book, so your billers would need to know that you actually performed an enterocele repair. The mccall culdoplasty did not lead to a disruption of the vaginal axis and. Western australian coding rule 071 mccalls culdoplasty accd coding rule mccalls culdoplasty ref no. Approaches to pelvic organ prolapse surgery workshop chair. Uterosacral ligament suspension at the time of primary prolapse repair represents a wellestablished surgical option.
Sacroespinous ligament fixation and modified mc call culdoplasty during vaginal hysterectomy for advanced uterovaginal prolapse. Modified mccall culdoplasty versus shull suspension in. In women with vaginal vault prolapse, abdominal sacrocolpopexy was shown to have a lower recurrence of vaginal. Modified mccall culdeplasty and vaginal vault suspension. Moschowitz culdoplasty another procedure for closing the space between the vagina and rectum through a vaginal incision. Effectiveness of the mccall culdeplasty in maintaining support after vaginal. In a randomized study, cruikshank and kovac8 demonstrated the superiority of mccall culdoplasty to uterosacral plication and simple peritoneal closure in the prevention of posthysterectomy enterocele. The mean parity in patients who underwent uterosacral plication was 3. Appropriate use of a vaginal apical support procedure at the time of prolapse surgery might reduce the longterm risk of recurrence 19. Mccalls culdoplasty another procedure for closing the space between the vagina and rectum and resuspending the top of the vagina through a vaginal incision. A mccall culdoplasty closes the space between the rectum and vagina through a vaginal incision to prevent the small bowel from pushing the vagina out.
This procedure not only supports the vaginal cuff but also closes off the culdesac, thus preventing the formation of an enterocele. Vaginal hysterectomy is a commonly performed for uterine prolapse. Apr 12, 2017 mccall culdoplasty and sacrospinous fixation can be carried out at vaginal hysterectomy. Comparison of patient reported outcomes, pelvic floor. After the mccall culdoplasty, we considered a vaginal vault at point c pdf the objective of the study is to evaluate the anatomical and functional results of the mccall culdoplasty in the treatment of moderate hysterocele. My obgyn performed a laparoscopic uterosacral plication and a high mccalls culdoplasty. In a randomized study, cruikshank and kovac8 demonstrated the superiority of mccall culdoplasty to uterosacral. The sutures are attached so that when tied, the uterosacralcardinal ligaments are drawn toward the. Sacrospinous ligament fixation of the vaginal apex is a widely used procedure. Sacrospinous ligament fixation and modified mccall.