Intrafascial abdominal and vaginal hysterectomy: a reappraisal

This study was designed to provide anatomic and physiologic evaluation of the intrafascial approach to hysterectomy. Anatomy of the pericervical fascia and its relationship to the fascial and muscular layers of the vagina and the cardinal and sacrouterine ligaments were studied in human and nonhuman primates. The effect of hysterectomy on the length, configuration, and axis of the vagina was evaluated using vaginal casts. Intrafascial abdominal and vaginal hysterectomies have many advantages. Damage to the urinary tract and bowel is minimized. Separation and later closure of the pericervical fascia may allow more effective hemostasis, obliterate dead space, decrease the area of raw surfaces, and separate the vaginal cuff from the retroperitoneal space. These are the principal factors in the prevention of postoperative infection. Intrafascial hysterectomy preserves the complex anatomic relationships between the endopelvic fascia and the vagina. It provides good vaginal support and preserves or improves the length, configuration, and axis of the vagina. Intrafascial hysterectomy is indicated only for treatment of benign disease.