Laparoscopic Surgery

Laparoscopic Sacrocolpopexy

Pelvic prolapse is the descent of various pelvic organs into and out of the vagina. The normal supporting structures weaken, a result of a number of factors, allowing the bladder (cystocoele), rectum (rectocoele), small bowel (enterocoele), or uterus to herniate. This results in the sensation of “something coming down”, dragging discomfort, lower back pain, incontinence, difficulties voiding urine or passing bowel motion, and discomfort with sexual intercourse.

There are a number of different surgical techniques for repair, each of which may be combined with anti-incontinence surgery when this is indicated. Where possible and in particular for multicompartment and more severe prolapse, abdominal rather than vaginal procedures are more reliable. Sacrocolpopexy involves re-suspending the uterus / vaginal vault to the apex of the sacrum, high in the pelvis, and reinforcing both front and back walls of the vagina, using permanent synthetic mesh.

There is a choice between an open or laparoscopic approach. Laparoscopy is associated with less pain, less blood loss, fewer problems and superior recovery when compared to the open procedure, allowing earlier return to normal function and fewer long-term complications. The scars are small and cosmetically superior. It follows the same principles as open surgery and achieves similar results in terms of cure of the underlying condition. However, the technique is more difficult and more expensive, with longer operating times.

The procedure is performed under general anaesthetic. Recovery is quick, up and about on the first day, with a hospital stay, in the majority of patients, of 1-3 days.

Pre-operatively:

• discontinue aspirin 1 week prior, other medications may need to be stopped
• enema the night prior and nil by mouth from midnight

Post-operatively:

• 1st post-operative day: mobilisation and diet, reinstate usual medications, catheter and vaginal pack removed
• oral antibiotics for 1 week
• resume full normal activity by 3-4 weeks

Whilst the outcomes of sacrocolpopexy are excellent, recurrent prolapse occurs in up to 15% of patients. This compares to a recurrence rate after vaginal repairs of <70%. Cystocoele repair may unmask urinary incontinence or rarely cause voiding difficulty and irritative urinary symptoms. Sexual difficulty and difficulties passing bowel motion are uncommon but have been reported. There is a small risk (<1%) of the mesh being infected or rejected, eroding into the vagina, and needing to be removed.

Other surgical complications occur overall in 5-10% of patients. Those recognised as common or serious are listed below but this does not include the rare and extraordinary. We try at all costs to avoid any adverse outcome.

This fact sheet complements the discussion during your consultation, which will apply your individual circumstances to the above facts.