What is a laparoscopic hysteropexy?
This procedure is performed on women who develop prolapse of the uterus (womb). This operation is performed to correct uterine prolapse without removing the uterus. The uterus is preserved using a prolene mesh, which acts as a new ligament to support and hitch up the uterus. This is an alternative option to vaginal hysterectomy, which Mr Rahmanou has extensive experience of performing.
This procedure allows the woman to preserve her fertility and uterus if she wishes. With this surgery, vaginal surgery is not usually required and there is less likelihood of a shortening of the vagina which occurs with vaginal hysterectomy. As the result there is less risk of subsequent sexual problems.
What does the operation involve?
The operation is performed using keyhole surgery under a general anaesthetic. There will be four small incisions on your abdomen for the camera and the instruments to perform the operation. A strip of permanent mesh is used to lift the uterus and hold it in place. One end of the mesh is wrapped around the cervix (neck of the womb) and the other attached to the ligaments over the sacrum (base of the lower back). The mesh is covered with the peritoneum (the layer of skin inside the abdomen). This reduces complications and the risk of adhesion of bowel to the mesh.
The effect of this operation is to support the womb and the vagina and prevent it from dropping down, restoring it to its normal anatomical position. Eventually, new connective tissue grows into the mesh, which forms a new strong ligament and remains permanently in the body.
Following the hysteropexy, further repairs may be required to correct any remaining vaginal wall prolapse. The vaginal repair operation tightens the walls of the vagina and the pelvic floor muscles. This will be done only if necessary during the same surgery or at a later date.
What specific complications can occur with this surgery?
The following complications can occur:
Urinary retention/voiding difficulty: This is the inability to pass urine. If this occurs, the urine can be drained using a catheter until you are able to pass urine independently, usually within 24 to 48 hours. If the problem persists, you will be taught Intermittent Self Catherisation (ISC). This is a procedure where you need to empty your bladder using a small tube or catheter.
Damage to surrounding organs: This can include bowel or blood vessels. This is rare but requires repair and this can result in a delay in recovery. Risk of damage to the bladder or ureters is low (2 in 1000 cases). Sometimes injury is not detected at the time of surgery and therefore requires a return to the operating theatre.
Mesh exposure or extrusion: Although there are known complications with meshes, in our experience these are very rare. None of our patients or those in other observational studies have experienced any complication with the technique used to perform this surgery.
Urinary incontinence: Unfortunately a small percentage of women develop stress incontinence after this operation even when it is not expected. You may find that you need further physiotherapy treatment or even surgery at a later date.
Pelvic pain: This can be related to adhesions around the pelvis.
Laparotomy: During surgery if there is injury in surrounding tissue or major vessels, a cut in the abdomen may be required.
What is the recovery following the laparoscopic hysteropexy?
Most women stay in hospital for two nights following laparoscopic hysteropexy. Occasionally a longer stay may be required.
Although the scars from laparoscopic (keyhole) surgery are small, the body still needs time to repair itself. Usually four to six weeks of recovery is needed. However, if vaginal repair is performed at the same time, a longer recovery may be needed.
You will have some stitches on the small incisions on your abdomen, which normally dissolve within two to three weeks of the operation. If you had vaginal repair, you will have vaginal stitches, which are also dissolvable.
For many women, sex after the operation is improved because there is no longer any discomfort due to prolapse. However, this may be different. We advise that you avoid penetrative intercourse for about six weeks or until after your check-up with your doctor. You are advised to use a vaginal lubricant (such as K-Y jelly) or vaginal moisturiser (such as Sylk or Replens). These are available to buy over the counter at your chemist. Some women may also benefit from vaginal oestrogen therapy.
As hysteropexy is an uterine preservation surgery, you will need to continue to have cervical smear tests as per routine recalls. Also, any unusual bleeding needs to be investigated following surgery, as for any other women.
How successful is the operation?
In our experience this operation has a more favourable outcome compared with vaginal hysterectomy, as strong uterine support can be achieved with a lower risk of recurrence. The recurrence of uterine prolapse has been as low as 2% in small studies.
