Minimally Invasive Treatment of Prolapse
There are many different types of surgeries to correct pelvic organ prolapse. Often, more than one of these surgeries will be performed at the same time. There are three different approaches to surgery. In the vaginal approach, the operation is performed through the vagina. In the abdominal approach, an incision is made on the abdomen (belly), this may be either a transverse (side-to-side) incision, or a vertical (up and down) incision. Prolapse surgery also may be performed laparoscopically, through several small (about one-centimeter) incisions on the abdomen.
In general, vaginal-approach surgeries have a faster recovery time and cause less pain than abdominal surgeries.
A vaginal hysterectomy is the removal of the uterus through the vagina, without any incision on the abdomen. When the uterus is very low in the vagina, or coming outside of the vagina, then it is usually necessary to remove the uterus in order to correct the prolapse. Removal of the tubes and ovaries may be done at the same time, and this is something that should be discussed with your doctor if you decide to have surgery.
Anterior Repair (anterior colporrhaphy)
An anterior repair is a vaginal surgery to correct a cystocele, when the “upper” wall of the vagina that is in contact with the bladder is sagging down, or coming outside of the vaginal opening. This is done by making a vertical incision in the skin of the vagina and folding the strong tissues just underneath the vaginal skin. By folding these tissues, and stitching them together, the “upper” wall of the vagina is no longer sagging or ballooning, and should become stronger as well. This type of surgery can help with a feeling of a bulge or pressure in the vagina. It may also help with the problem of not being able to empty your bladder completely. Once things are back in proper alignment, it should be easier to urinate and empty the bladder.
Posterior Repair (posterior colporrhaphy)
A posterior repair is a vaginal surgery to correct a rectocele, when the “lower” wall of the vagina that is in contact with the rectum is bulging into the vagina, or coming outside of the opening of the vagina. This is done by making a triangular or diamond-shaped incision, and removing some of the extra skin of the wall of the vagina. After this skin is removed, the strong tissues underneath are brought together with strong stitches. This type of surgery can help with a feeling of a bulge or pressure in the vagina. It sometimes helps a woman to empty her bowels more efficiently.
Sacrospinous Ligament Suspension
A sacrospinous ligament suspension is a vaginal surgery that is used to re-attach the “top” or “apex” of the vagina when it has come down. Normally, the vagina is held in place by the combined action of ligaments (sometimes called “fascias”) and muscles. The primary problem occurs in women with vaginal prolapse when the tissues fail that normally hold the top of the vagina in place. This operation attaches the vagina to the sacrospinous ligament through the vagina. An incision is made at the top of the vagina – not through the abdomen. The surgeon then reaches up to the ligament, puts four stitches into it, and then uses these stitches to tie the top of the vagina up. This pulls up the vagina to a normal position. If the front wall is still dropped, then an anterior repair is done; and if the back wall is falling, a posterior repair also is done. During the operation, the surgeon will correct any abnormal areas.
Uterosacral Ligament Suspension
Uterosacral ligament suspension is a vaginal surgery that is used to re-attach the “top” or “apex” of the vagina when it has come down. The “top” or “cuff” of the vagina is sewn to two strong ligaments, called the “uterosacral ligaments,” deep in the pelvis.” After the surgery, the top of the vagina should be deep inside of the body, instead of coming out, as it was before. One possible risk of this surgery is the possibility of injuring the urethra, which is the tube that carries urine between the kidney and the bladder.
In general, abdominal-approach surgeries have a longer recovery time and generally cause more discomfort than vaginal surgeries. Sometimes, however, due to the patient’s anatomy or other existing conditions, the only approach can be an abdominal one.
Laparoscopic Reconstructive Surgery
Laparoscopic sacrocolpopexy is done to correct a prolapse when the “top” or “apex” of the vagina has come down. An incision is made on the abdomen (either transverse or vertical), and a mesh is used to attach the top of the vagina to a strong ligament that lies along the sacrum, which is part of the pelvic bone. Sometimes a posterior repair will be done at the same time, if there also is a rectocele. When this procedure is done open a patient has large abdominal incision. Now with laparoscopy patients typically go home the next day versus staying about 3-4 days.
Laparoscopic prolapse repair is performed through several very small (one-centimeter) incisions, with the use of a video camera. Abdominal sacrocolpopexy, and uterosacral ligament suspension can be done with the laparoscope. One advantage of laparoscopic surgery is that recovery time is faster than with abdominal surgery, and postoperative pain is usually less than abdominal-approach surgeries.