Cervicopexy (transvaginal)

• A technique that is considered to aid in the retention of an acute or chronic vaginal prolapse.
• The cervicopexy technique results in the fixation of the external os of the cervix to the prepubic tendon.
• The cervicopexy procedure is ideal for situations where the vaginal prolapse is associated with excessive redundancy of the ventral vaginal wall.
• There are two possible approaches when performing the cervicopexy:
  • Via a flank laparotomy:
    • The flank laparotomy approach allows for the cervix to be more precisely fixed in place.
    • There is reduced risk of bladder and intestinal entrapment,
  • Via a vaginal approach (transvaginal approach):
    • The transvaginal approach is less invasive and easier to perform.

• The procedure is carried out once the vagina has been replaced. Prolapse correction

Uses

Advantages

• Minimally invasive surgical approach for the management of a vaginal prolapse.
• Relatively easy surgical procedure to carry out.
• Can be carried out under field conditions.

Disadvantages

• There are a number of potential disadvantages of the cervicopexy procedure, these include:
  • Entrapment of the urethra.
  • Entrapment of the bladder.
  • Entrapment of the intestines.
  • Risk for bacterial infection.
  • Narrowing of the cervical lumen.
  • Altered positioning of the vagina.

Technical problems

• There is a risk of entrapment of abdominal organs when surgically fixing the cervix to the prepubic tendon.
• The cervicopexy procedure is a difficult procedure to carry out in over conditioned cattle.

Alternative techniques

Caslick procedure Caslick procedure.

Buhner method Buhner method.

Bootlace technique:

• Several (4 to 5) small eyelets composed of umbilical tape are inserted along each side of the vulva at the haired and hairless junction.
• Tape is then laced through the eyelets (similarly to how shoelaces are laced).
• As the tape is tightened, the labia tend to invert into the vulva, disrupting the labial seal.

Horizontal mattress suture (halstead) technique Surgery: suture patterns - overview:

• A suture needle and suture are passed through the deep tissues at the base of the dorsal aspect of the labium and then across the vulvar cleft, through the base of the contralateral labium.
• The needle is then reinserted through the labia in the same plane, approximately 2-3 cm ventrally to the previous stand.
• This process is repeated with several 2-3 more horizontal mattress sutures placed ventrally to one another, until the opening from the ventral commissure is a 2 – 3 finger sized opening.

Deep vertical mattress suture technique:

• This technique is similar to the horizontal mattress suture (halstead) technique described. The technique differs only in that vertical mattress sutures are inserted, rather than horizontal mattress sutures.

Johnson button:

• This technique is indicated in situations where the vaginal prolapse is associated with excessive redundancy of the dorsal vaginal wall.
• An indwelling needle is placed from the dorsolateral wall of the vagina through the sacrotuberous ligament, the gluteal musculature, and then the skin.
• To hold the needle in place, a flat disc (buttons) is attached to each end of the needle.  
• The needle is removed after 2-6 weeks after extensive fibrous scaring has occurred. 

Minchev suture:

• This technique is also indicated in situations where the vaginal prolapse is associated with excessive redundancy of the dorsal vaginal wall.
• Umbilical tape is used to suture from the dorsolateral wall of the vagina through the sacrotuberous ligament, the gluteal musculature, and the skin.
• Rolled gauze sponges are attached to each end of the umbilical tape to hold the tape in place.
• The umbilical tape is removed after 2-6 weeks after extensive fibrous scaring has occurred. 
• Vaginoplasty/vaginal tissue resection:
  • Surgical removal of the injured vaginal tissue and end to end anastomosis of the remaining tissues of the vagina is carried out.

Time required

Transvaginal technique

Preparation

• 5 – 15 minutes (if it is required to replace the vaginal prolapse prior to performing the cervicopexy).

Procedure

• 10 – 20 minutes (this will be dependent on clinical experience).

Decision taking

Criteria for choosing technique

• Vaginal prolapse (acute or chronic), with excessive redundancy of the ventral vaginal wall.
•  The cow is not excessively over conditioned.
• The vaginal tissue is viable.

Risk assessment

• The prolapsed tissue should be thoroughly examined to assess for evidence of trauma and viability. 
• The bladder and urethra are located prior to attempting the procedure.