A New Surgical Technique for Enterocele Repair by Vaginal Route: Aytan Method

The aim of this report is to demonstrate a new surgical technique to repair posterior enterocele by vaginal route. The optimal surgical repair method of the enterocele is still not known. Abdominal approaches include Moschcowitz culdoplasty, the Halban procedure and uterosacral ligament plication and vaginal techniques include vaginal enterocele repair and McCall culdoplasty. In all of the vaginal and abdominal approaches there is intraperitoneal entry. The main difference in this new technique is that the enterocele sac is reduced extraperitoneally. After the enterocele sac is dissected completely off from the vaginal epithelium, the uterosacral ligaments are held without entering into the peritoneum. A series of parallel sagittal sutures are placed on the enterocele sac starting from the most caudal part of the sac going all the way to the ipsilateral uterosacral ligament. A total of 5 parallel suture lines are placed on the peritoneal sac. These sutures are knotted one by one while the assistant reduces the sac inside and just after the sac is completely reduced, the rectovaginal septum is carefully reconstructed by suturing the remnants of the rectovaginal fascia. The excess vaginal epithelium is trimmed and the perineal body is supported by additional sutures. This is a new surgical method for transvaginal enterocele repair which is done extraperitoneally.