Pelvic Prolapse Repair

Diagram of laparoscopic incision, showing four small spots across the abdomen
Effigy 1. Laparoscopic approach

For many women, prolapse can include descent of the uterus, vagina, float and/or rectum resulting in a "bulging" sensation within the vagina. In some cases, frank protrusion of these organs can occur. Pelvic organ prolapse can issue in symptoms including urinary leakage, constipation, and difficulty with intercourse.

Laparoscopic colposuspension is a minimally invasive surgical technique that provides a safety and durable method for reconstruction of the pelvic floor and its contents without the need for a large abdominal incision.

The Surgery

Laparoscopic colposuspension is performed using fine laparoscopic instrumentation inserted through four keyhole incisions across the mid abdomen (Effigy 1).

Diagram of lower midline incision, showing a vertical line down the abdomen to the groin
Figure 2A.Lower midline incision

This is in contrast to the conventional open up intestinal colposuspension where a lower midline (Effigy 2a) or Pfannenstiel (Figure 2b) abdominal incision is required.

In cases of pelvic organ prolapse, there is laxity of vaginal back up resulting in protrusion of the pelvic organs. The goal of laparoscopic colposuspension is to resuspend the vagina and associated pelvic organs through the key-hole incisions. In sure circumstances, a simultaneous hysterectomy, bladder suspension, or rectocele repair may exist required, all of which can be accomplished through a vaginal approach.

Laparoscopic colposuspension is a well established procedure at Johns Hopkins Bayview Medical Center and is performed with the assistance of an experienced and dedicated laparoscopic surgical team including nurses, anesthesiologists, operating room technicians, many of whom y'all volition meet the 24-hour interval of surgery.

Diagram of Pfannenstiel incision, showing a horizontal line across the groin
Figure 2B. Pfannenstiel incision

Laparoscopic colposuspension is performed through four pocket-sized keyhole (0.five-i cm) incisions across the mid belly (Figure ane). Through these minor incisions, fine laparoscopic instruments are inserted to dissect and suture. Fantabulous visualization of the pelvic organs is achieved with the use of a high-powered telescopic lens attached to a photographic camera device, which is inserted into one of the keyhole incisions.

The vagina and pelvic organs are then resuspended internally with a combination of sutures and a supportive mesh or fascial graft (Figure 3). If needed, a bladder suspension, vaginal hysterectomy, and rectocele repair tin can be achieved at the aforementioned time via a vaginal incision. A Foley catheter (i.e. bladder catheter) is placed to drain the bladder. A gauze vaginal packing is also placed at the end of the procedure.

The length of operative time for laparoscopic colposuspension can vary profoundly (three-5 hours) from patient to patient depending on the internal anatomy, shape of the pelvis, weight of the patient, and presence of scarring or inflammation in the pelvis due to infection or prior abdominal/pelvic surgery.

Blood loss during laparoscopic colposuspension is routinely less than 200 cc and transfusions are rarely required.

Diagram of colposuspension with mesh graft

Figure 3. Schematic sagittal view of laparoscopic colposuspension with mesh graft.

Potential Risks and Complications

Although laparoscopic colposuspension has proven to exist very prophylactic, as in whatsoever surgical procedure there are risks and potential complications. Potential risks include:

  • Bleeding: Although blood loss during this procedure is relatively low compared to open up surgery, a transfusion may nevertheless be required if deemed necessary either during the operation or later on during the postoperative menstruum.

  • Infection: All patients are treated with intravenous antibiotics, prior to the start of surgery to subtract the hazard of infection from occurring within the urinary tract or at the incision sites.

  • Next Tissue / Organ Injury: Although uncommon, possible injury to surrounding tissue and organs including bowel, vascular structures, pelvic musculature, and fretfulness could crave further procedures. Transient injury to fretfulness or muscles can also occur related to patient positioning during the operation.

  • Hernia: Hernias at the incision sites rarely occur since all keyhole incisions are closed under direct laparoscopic view.

  • Conversion to Open Surgery: The surgical procedure may crave conversion to the standard open up performance if extreme difficulty is encountered during the laparoscopic procedure (e.thou. excess scarring or bleeding). This could consequence in a standard open incision and possibly a longer recuperation period.

  • Urinary Incontinence: Pre-existing urinary incontinence volition typically be addressed at the time of surgery with a float sling pause, however, pocket-size incontinence may still exist, which typically resolves with fourth dimension. On occasion, medication may exist required.

  • Urinary Retentivity: As with urinary incontinence, postoperative urinary retention is uncommon and usually is present in patients who undergo concurrent float sling suspension. Temporary intermittent self-catheterization may exist required postoperatively.

  • Vesicovaginal fistula: A fistula (abnormal connection) between the bladder and vagina is a rare complication of any pelvic surgery involving the vagina, uterus, and bladder. A vesicovaginal fistula typically manifests with symptoms of continuous urinary leakage from the vagina. Although rare, these fistulas can be managed conservatively or by surgical repair through an vaginal incision.