Laporascopic hysteropexy involves a lifting up and reinforcing the support structures of a uterus. It is a surgical procedure for women who are troubled by prolapse (a feeling of falling down or heaviness in the vagina) of their womb. When performing a hysteropexy (images or video), we wrap a special reinforcement mesh / netting around the neck of the womb (the cervix) and fix this to some strong tough areas (ligaments) on the base of the spine. This is what keeps the womb in place and we hope that by using this special mesh material, that the womb will be unable to fall down or prolapse again. In younger women or those who may desire future pregnancies we use a tape (uterine sling – images) to support the uterus as this does not wrap around the cervix and may be better in these situations. The principles of the operation are the same for both methods.
Hysteropexy is used as a treatment for women with prolapse of their womb (uterus). It is a womb-sparing procedure, as it does not involve removing the womb (hysterectomy). It is chosen by those women who for whatever reason are keen to not have their uterus removed. We hope that by not subjecting woman to much of the necessary surgical cutting involved in performing a hysterectomy, that also a woman’s recovery will be quicker, and that she will be able to return to daily activities sooner than is normally the case with hysterectomy. If your preference is to have your womb removed, a hysterectomy would be a more appropriate operation. If you have any doubts regarding surgery we would advocate trying non-surgical treatments first.
Prior to surgery:
Women complain of typical prolapse symptoms, which include a heaviness or dragging sensation inside the vagina. Many women can see or feel a lump protruding, and may have associated impairment in bowel, bladder and sexual function. The objective of the operation is to relieve your symptoms, and restore vaginal anatomy.
With any prolapse surgery, there is always a chance that prolapse can return and it is estimated that between one in three and four women will require repeat surgery for prolapse. This is because many women with prolapse have weak tissue which increases the chances of further prolapse developing. We hope that by using reinforcing mesh during the operation, that the chances of developing repeat prolapse are reduced. Even despite this though, prolapse can come back, or more likely may come back in different parts of the vagina (the front or the back walls) that have not been repaired at the initial operation.
We are able to perform this operation through keyhole surgery (“laparoscopic hysteropexy”), which offers the advantages of less scarring and a quicker recovery, than when the operation is performed through a larger abdominal incision.
What happens after the operation?
After the operation, you may experience nausea and wound pain. Medication will be given to relieve these symptoms. You will normally be allowed to drink on the same day of operation. The urinary catheter will be removed usually after one-two days. Some women will already have gone home and may return to have the catheter removed. The nurse looking after you will make sure you are passing water without a problem and check there is not a large volume of urine left in the bladder after you have finished urinating. A small number of women will inadequately empty their bladders. They will go home with a catheter in and come back a week later for removal of the catheter. If a vaginal pack / bandage is used at the time of surgery, it is removed the following day.
You are likely to be able to start a light diet after surgery. It is particularly important that you keep your bowel habit regular and avoid straining. We may prescribe a stool softener to facilitate this. You are likely to experience pain in the abdomen / pelvis that will require regular painkillers for a few weeks following surgery. Your doctor may also prescribe some oestrogen cream to be used for a few weeks following surgery to aid vaginal healing.
Are there any risks?
Laparoscopic hysteropexy is safe and very effective, but as with any surgical procedure there are risks attached. Some women have such dense scarring because of their previous surgery that preclude us from performing the procedure safely with keyhole surgery, and we may need to perform the prolapse repair via the vagina. This is very rare. The risks common to all operations include anaesthetic risks, infection, bleeding, recurrence of symptoms and formation of a blood clot in the legs/lungs.
The main risks specific to laparoscopic hysteropexy are:
- Damage to surrounding structures: This includes bowel, bladder or ureters (pipes leading from the kidneys to the bladder). The risk of this is small although is increased the more abdominal / pelvic operations you have had. In general, if such a complication were to occur, we would repair the damage that had been caused. This may mean repairing the bladder, and may mean that the catheter (plastic tube to drain the bladder) has to be kept for a couple of weeks after surgery. It may mean repairing the bowel (and perhaps requiring a larger cut or “laparotomy”) and this may mean that parts of the bowel need to be temporarily rested and a special bag (“colostomy”) used for a few weeks following surgery. To reiterate, these risks are extremely uncommon (less than 1%), but every woman is warned about them.
- Slow return to satisfactory bowel or bladder function:
- Most women complain of these symptoms prior to surgery, and in fact if anything may be improved by surgery. Some women notice a worsening or urinary leakage after prolapse surgery. This occurs not because the surgery has caused the problem, but that it reveals a pre-existing problem with the bladder. The prolapse had previously been masking the bladder incontinence problem, and now that the prolapse is corrected, the baldder problem becomes apparent. This affects a small number of women, may be predictable before the operation depending on your symptoms, examination findings and tests, and is often relatively easily treated following surgery. Some women may require a subsequent small surgical procedure to correct this problem.
- Erosion of mesh material: With any foreign body material, the body may reject the mesh. This may mean that the mesh becomes incorporated into the bowel, bladder or vagina. This may affect the relevant structure’s function, and may mean the mesh needs to be surgically removed. This is very uncommon (less than 5%). To our knowledge, for our technique of laparoscopic hysteropexy, no-one has required removal of the mesh material, although it remains a possible risk.
- The need for a laparotomy (wider cut in the abdomen): This is a risk for anyone undergoing a laparoscopy, and occurs if there is significant bleeding or damage to surrounding structures, and is very unlikely (less than 2%).
- Infection: An extremely rare theoretical risk of the operation is that an infection may develop in the spine after attachment of the mesh. If this were to happen, you may require strong antibiotics and the mesh may need to be removed.
What should I do after the operation?
You should be back on your feet relatively quickly, but you avoid heavy lifting for 6 weeks. There may be some bleeding / brown vaginal discharge as the wounds in the vagina heal which is completely normal. Remember this is major surgery, and you may require regular painkillers for a few weeks following surgery.
Sexual intercourse may be resumed after 6 weeks if you are feeling comfortable and the discharge has stopped. We generally suggest 3 to 4 weeks off work.