Laparoscopic Suture Hysteropexy


Aim

Correct uterine prolapse. The cause of upper genital prolapse is weakness of the uterosacral and cardinal ligaments. This surgery aims to reestablish these normal anatomical supports.

Indication

Uterine prolapse in women wishing to preserve the uterus ie considering further family, believe the cervix important in sexual response or that a non diseased organ should not be removed.

Surgical Technique

  • This surgery is performed under general anesthesia.
  • Three small laparoscopic incisions are made in the abdomen totaling 2cm.
  • The patient is placed in a head down tilt so the bowel is able to move away from the operating site and uterus is tilted forward.
  • The cul de sac (area between the uterus and rectum) is sutured closed including the cardinal ligaments.
  • The uterosacral ligaments are shortened and sutured to the back of the cervix mimicking the natural supports of the upper vagina.
  • The integrity of the upper renal tract is checked at the end of the surgery
  • Other sites of prolapse are corrected as needed at the end of the surgery
  • Skin incisions are closed with absorbable sutures.
  • A catheter is usually placed in the bladder for the first 24hr.

Complications

  • failure rate of 10-15%
  • Urinary tract infections and wound infections in 2-5% of patients.
  • blood loss requiring transfusion < 1%
  • Clotting in the legs or lungs < 1%
  • A very small risk of damage to the bowel or urinary system during the procedure <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 and on how you feel.