Laparoscopic sacrocolpopexy

This is a procedure performed on women who have developed vault prolapse after a hysterectomy. It is an abdominal laparoscopic (keyhole) procedure with a permanent mesh.

The operation is performed under general anaesthetic through a laparoscope (keyhole surgery). There will be four small incisions on your abdomen for introducing the camera and the instruments to perform the operation. A piece of permanent (non-dissolvable) fine mesh is used to attach the top of the vagina to the ligaments over the sacrum (the base of the lower back). This supports the vagina and prevents it from prolapsing. The mesh is covered with peritoneum (the layer of skin inside the abdomen). This reduces the risk of adhesion of the bowel to the mesh.

The effect of this operation is to support the top of the vagina and prevent it from falling, restoring it to its normal anatomical position. Eventually, new connective tissue grows into the mesh, which forms a new strong ligament.

Following the sacrocolpopexy, 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.

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, bladder or ureters. This can occur in 2% of cases, requiring repair and a potential delay to recovery. The risk of damage to the blood vessels is very low. Sometimes injury is not detected at the time of surgery and therefore requires a return to the operating theatre.

Mesh exposure or extrusion (mesh wears away the surrounding tissues): The risk of this is low, at about one or two patients in 100. You may get symptoms of discharge or bleeding if this happens. You may require a repeat operation to trim the mesh.

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.

Chronic pain: This can be related to adhesions around the pelvis. Pain (generally or during intercourse) occurs in two or three patients in 100.

Laparotomy: During surgery if there is an injury to surrounding tissue or major vessels, a cut in the abdomen may be required.

Most women stay in hospital for two nights following laparoscopic sacrocolpopexy. 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 need any vaginal repair, you will have vaginal stitches, which are also dissolvable.

There is a risk of constipation for several weeks after surgery, and we can prescribe laxatives. No stitches will be damaged when the bowels do open, which will usually happen about two to three days after surgery.

You should be able to be fit enough for light activities within a month of surgery. However, we recommend you avoid very heavy lifting, heavy household chores, driving and sport for at least six to eight weeks to allow the wounds to heal. Most people need about six to eight weeks off work.

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.

After the operation the top of the vagina should not come down as it is firmly supported. This is the most successful operation for curing prolapse of the vaginal vault. This is an established operation with a success rate of 90%. You should feel more comfortable after the operation and the sensation of prolapse should have gone.

As the procedure is performed via laparoscope (keyhole) it has limited disruption to the surrounding organs such as bowel and bladder with a quicker recovery afterwards.