Laparoscopic Paravaginal Repair


Aim

Is the correction of lateral vaginal defects causing cystoceles. The vagina and supporting fascia are resupported to their natural anatomical position

Indication

Management of cystoceles (bladder prolapse) treatment of stress incontinence with cystocele

Surgical Technique

This surgery can only be performed under general anaesthesia (fully asleep). The surgical approach is similar to the laparoscopic colposuspension. Three small incisions are made in the skin and entry is gained to the space between the pubic bones and bladder. The anterior vaginal fascia is sutured to the lateral pelvic wall using 4-5 sutures on each side of the bladder. This is shown in the diagram below. At the completion of the surgery a cystoscopy (look inside the bladder) is performed to ensure no damage has occurred to the lower urinary tract. The small trocar sites (incision sites) in the skin are closed with absorbable sutures.

 

Complications

  • Failure to correct cystocele or stress incontinence in 10%
  • Urinary urgency or urge incontinence in 5%
  • Urinary tract infections and wound infections in 2-5% of patients.
  • Difficulty emptying the bladder that necessitates the use of prolonged catheter use or self catheterisation in less than 1% of patients
  • Blood loss requiring transfusion < 1%
  • Clotting in the legs or lungs < 1%
  • Damage to the urinary system in <1%
  • Conversion to open surgery in <1%.

In hospital and recovery

You can expect a 2 - 3 day hospitalisation. After the operation you will have an I.V. drip in your arm and a small catheter will drain your bladder for 24hrs.

In the early postoperative period the nurses will check that you are emptying your bladder appropriately. Absorbable sutures are used on the skin that do not need to be removed

During recovery

In the early postoperative period you should avoid situations where excessive pressure is placed on the repair ie lifting, straining, coughing and constipation. Maximal fibrosis around the repair occurs at 3 months and care needs to be taken during this time. If you develop urinary burning, frequency or urgency you should see your local doctor. You will see Dr Maher at 6 weeks for a review and sexual activity can usually be safely resumed at this time. You can return to work at approximately 4-6 weeks depending on the amount of strain that will be placed on the repair at your work and on how you feel.