Laparoscopic sacrocolpopexy is an operation which involves supporting the vagina to the ligament on the spine (after previous surgery to remove the womb) by using a synthetic mesh. It is an effective treatment for women with vault prolapse, which is when the roof (or vault) of the vagina has collapsed in a woman who has already had a hysterectomy.
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.
We are able to perform this operation through keyhole surgery (“laparoscopic sacrocolpopexy” – diagram or video), 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 sacrocolpopexy 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 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 sacrocolpopexy 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. If the bowel were to be inadvertently damaged it can be repaired at the time of surgery, although it may mean that a part of the bowel will need to be temporarily rested with a special bag (a colostomy) whilst the bowel heals. We are likely still to perform the prolapse repair, although it may be performed with stitches rather than mesh.
- 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.
- Ersosion 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%).
- Pain on intercourse: Many women are unable to satisfactorily make love because of their prolapse, and one anticipates that after surgical correction of the prolapse this symptom improves. Some women will have persisistent pain because of the mesh reinforcing the vaginal support, although we use a soft lightweight mesh to minimize this possibility.
- 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 6 weeks off work.