PELVIC ORGAN PROLAPSE SURGERY

Pelvic organ prolapse is a general term used to describe several kinds of prolapse conditions. If a prolapse is not too severe, it can be treated with several non-surgical techniques; however, at some point prolapse surgery may be the most effective way to correct the bulging tissue.

Types of Prolapse

Uterine Prolapse – A uterine prolapse occurs when the womb (uterus) drops into the vagina. This type of prolapse is the second most common kind that occurs. When an individual is not planning to have a baby, the surgeon might recommend a hysterectomy to remove her uterus. The preferred surgical approach is the laparoscopic uterine suspension.

Cystocele – This type of prolapse frequently involves the bladder and is also referred to as bladder prolapse or anterior prolapse.

During a bladder prolapse surgery to correct this condition, the surgeon repositions the bladder and secures it with the use of connective tissue. This connective tissue is located between the bladder and vagina. The surgeon will also remove any excess tissue at this time. If an individual is suffering with urinary incontinence, he may also use a sling or bladder neck suspension to support the patient’s urethra.

The benefits of cystocele surgery can last for years; however, there is a chance that this condition will re-occur. Should this happen, another surgery may be necessary.

Posterior Prolapse – This kind of prolapse generally involves the rectum. It is referred to as a rectocele. The surgeon helps the rectum remain in its proper position by securing the connective tissue that is between the rectum and the vagina. The surgeon will remove any excess tissue at this time as well.

Small Bowel Prolapse/Vaginal Vault Prolapse

A small bowel prolapse may also be referred to as an enterocele. If a woman is suffering this condition and has previously undergone a hysterectomy, this kind of prolapse is referred to as a vaginal vault prolapse. A vaginal vault prolapse could involve the rectum, bladder or small bowel.

Prolapse Surgery – Surgical Methods

All the above corrective surgical procedures can be performed via either the (i) vaginal approach, or (ii) the abdominal approach.

(i) The Vaginal Surgical Approach  This approach involves an incision being made in the vagina. The surgeon proceeds to separate the prolapsed organ from the vaginal wall before using stitches and/or mesh**  (** see below) to repair the vagina. The surgeon may also use the ligaments in the pelvis to provide additional support to the uterus.

(ii) The Abdominal Approach This approach involves an incision being made in the abdomen. The surgeon may choose to use a graft of the patient’s tissue, synthetic mesh** (** see below) or donor tissue to assist in supporting the vaginal tissues. This approach may be performed as an open procedure (by hand), laparoscopically or robotically. Whilst the procedures are similar, the latter two options typically result in quicker recovery times and smaller scars. This is because of smaller incisions, made possible by the use of precision equipment.

The robotic approach is currently offered in only a few centers.

Laparoscopic surgery  Laparoscopic surgeries, also known as keyhole surgeries, are completed using a lighted device similar to a camera (laparoscope) to help guide the surgeon and special robot-like surgical instruments. This approach offers several advantages over the traditional abdominal approach – the surgeon can clearly see as well as feel the defects pelvic floor, allowing for much greater precision.

Success Rate of Vaginal and Abdominal Surgical Intervention

Nearly 75 percent of the women who have vaginal surgery and 90 to 95 percent of the women who have the abdominal surgical approach will experience a long-term cure for the symptoms related to their prolapse. That said recurrent prolapse is possible if the factors that originally caused the prolapse continue (constipation, weak tissues, etc.).

Vaginal Closure Surgery

This surgery is referred to as colpocliesis. Women suffering with severe prolapse who are not and never plan to be sexually active or who are medically unfit to have reconstructive surgery may be offered a colpocliesis.

During the colpocliesis procedure, the surgeon stitches the vaginal walls together, which prevents the prolapse from re-occurring. Recovery time for this kind of procedure is quick and the surgical time is short.

Success Rate of the Colpocliesis Procedure

This procedure has a 90 to 95 percent success rate. Each patient is different so the surgeon will decide which procedure best suits the individual circumstances and needs of his patient. Each surgery has its pros and cons. The surgeon will discuss the positives and negatives of the surgery he recommends.

If Surgery is Not an Option, a Vaginal Pessary May be Recommended

A woman that has major medical problems may not be a candidate for surgical intervention because the risks may outweigh the benefits. In a circumstance such as this, the surgeon may recommend a vaginal pessary as the best treatment for the bothersome symptoms associated with pelvic organ prolapse. A pessary is a customized device that is inserted into the vagina to provide structural support.

Risks/Complications in Prolapse Surgery

Any kind of surgery has risks. Each patient’s surgeon will discuss the risks associated with the particular surgery that will be performed.

That said, some of the possible complications for all prolapse surgeries include:

  • Damage to surrounding organs.
  • Excessive bleeding that may necessitate a blood transfusion.
  • An infection requiring the use of antibiotics: to reduce the possibility of infection, some surgeons automatically have their patients take antibiotics during and following their surgery.
  • Deep vein thrombosis (DVT), which is when a blood clot forms in a vein (for instance, in the leg) some surgeons automatically give their patients medication to reduce the risk of DVT occurring.
  • Vaginal bleeding and/or discharge.
  • Pain during intercourse, which is generally caused because the vagina has become narrow.
  • Additional problems with prolapse requiring another surgical procedure.
  • see ** below regarding possible complications from use of synthetic mesh.

What to Expect Following Prolapse Surgery

While countless prolapse operations are considered outpatient surgeries and do not require an overnight stay, there are some major prolapse operations that will require a one or two day stay in the hospital.

If a hospital stay is required, the patient may receive intravenous fluids and/or have a catheter placed to drain her urine. The surgeon will place gauze inside her vagina. This gauze acts like a bandage and remains in the vagina for the initial 24 hours following surgery. Her stitches will dissolve after a few weeks.

The Recovery Process

For several days or weeks following surgery, a patient may experience vaginal bleeding that resembles her menstrual cycle. She may also have a vaginal discharge that could last up to four weeks. Tampons should never be used following this kind of surgery. Sanitary napkins are recommended.

Post-Surgery Recommendations

  • The surgeon and his staff will advise the patient which activities she needs to avoid and for how long.
  • Most of the time, a patient can shower or bathe once she returns home. However, swimming should be avoided for several weeks following surgery.
  • Sexual intercourse will need to be avoided as recommended by the surgeon.
  • The surgeon will also decide when the patient is able to return to work.

Problems to Watch for During Recovery

Vaginal discharge is expected. If the amount of discharge begins to increase or has a foul odor, the patient should contact her general practitioner (GP) because she may have an infection.

Other Reasons to Contact the GP Include:

  • A fever of 104 degrees Fahrenheit (40 degrees Celsius) or higher;
  • Excessive vaginal bleeding;
  • Extreme pain in lower abdomen; and/or
  • A burning or stinging sensation while urinating.

Knowing What to Expect

Pelvic organ prolapse is experienced by approximately 40 percent of women. Not all women will need surgery to correct their pelvic organ prolapse. However, for those who do, knowing what to expect may help eliminate some of the anxiety related to these kinds of surgical procedures.

 

** Synthetic mesh: Note that the use of synthetic mesh has resulted in mesh-rejection complications for many patients. Originally thought to be rare incidents, there has been a rising number of cases which may be a cause for concern about the continued use of synthetic mesh. Complications include severe pain, difficulty in urinating, infection, bleeding, organ perforation, mesh shrinkage and the return of prolapse or incontinence. Removal of the synthetic mesh, once surgery has been performed, may not be possible. You are advised to discuss this with your medical practitioner. For further information, see http://meshmedicaldevicenewsdesk.com.

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