Properly rebuilt perineal body is critical element of prolapse repair: vaginal reconstructive surgery.
Think of the perineal body as a pyramid, with the base almost parallel to the floor between the vaginal introitus and the anus, and with the apex--approximately 3-4 cm high--found at the junction of the lower to middle third of the vagina where it angles and becomes almost horizontal.
Reconstruction based on this definition will help in recreating the proper orientation and axis of the vagina, and will provide good support to the vagina. It will also provide for proper positioning of the anus, said Dr. Rogers of Reading Hospital and Medical Center, West Reading, Pa.
"Most women with prolapse have prolapse of the anal canal and the anus," he said, explaining that the anus should actually be positioned 1-2 cm above the level of the ischial tuberosity.
Normal anatomy can be recreated by properly reconstructing the perineal body, attaching the top of the rectovaginal septum to it, and pulling it up into the pelvis. This gives the vagina support much like the levator plate, and brings the anus where it belongs, he said at the meeting, which was sponsored by the Society of Pelvic Reconstructive Surgeons and Emory University.
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|Publication:||OB GYN News|
|Date:||Nov 15, 2003|
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