Sacrocolpopexy with hysterectomy is a surgical procedure designed to address pelvic organ prolapse, a condition where pelvic organs descend from their normal position. This combined approach simultaneously corrects the prolapse and removes the uterus, offering a comprehensive solution for individuals experiencing both uterine issues and pelvic floor weakness. The procedure aims to restore anatomical support and improve quality of life.
Understanding the Combined Procedure
Sacrocolpopexy corrects pelvic organ prolapse, especially when the vaginal vault has descended. During this procedure, a synthetic mesh is used to lift and secure the vagina to the sacrum, a triangular bone at the base of the spine. This mesh provides durable, long-term support to the pelvic floor structures.
Hysterectomy involves the surgical removal of the uterus. It is performed alongside sacrocolpopexy when uterine prolapse is present. It is also considered if other uterine conditions, such as uterine fibroids, abnormal uterine bleeding, or adenomyosis, coexist with pelvic organ prolapse, requiring uterine removal for symptom relief. Combining these two procedures in a single surgery can reduce the need for multiple operations and provide a more complete resolution for complex pelvic floor disorders.
Surgical Approaches and Steps
Sacrocolpopexy with hysterectomy can be performed using different surgical approaches. The open abdominal approach involves a larger incision in the lower abdomen, providing the surgeon a direct view of the pelvic organs and allowing for tissue repair.
The laparoscopic approach uses several small incisions in the abdomen, through which a thin, lighted tube with a camera (laparoscope) and specialized surgical instruments are inserted. This minimally invasive technique offers magnified visualization on a monitor, allowing for precise work with less trauma to surrounding tissues. A robotic-assisted laparoscopic approach further enhances this by providing the surgeon with a 3D view and robotic arms that offer greater dexterity and range of motion than traditional laparoscopy.
Regardless of the approach, surgical steps involve removing the uterus first. Following the hysterectomy, the surgical mesh is carefully positioned. The mesh is then attached to the vaginal vault and secured to the sacrum. This attachment creates a stable suspension system, lifting and supporting the pelvic organs to their correct anatomical position.
Preparing for and Recovering from Surgery
Preparing for sacrocolpopexy with hysterectomy involves several pre-operative steps. Patients undergo thorough medical evaluations, including blood tests, imaging, and a physical examination to assess overall health and risks. Discussions with the surgical team review the procedure and address concerns. Patients may be advised to stop certain medications, like blood thinners, and to cease smoking several weeks before surgery to improve healing.
The recovery process involves a hospital stay of about 2 nights, although some individuals may be discharged sooner. Post-operative pain is managed with oral painkillers, which should be taken regularly to facilitate early mobilization. Patients are encouraged to sit up and walk on the same day as surgery to aid circulation.
Activity restrictions are in place during recovery. Heavy lifting, pulling, or pushing, particularly anything heavier than 10 pounds (about 5 kg), should be avoided for up to three months. Driving is restricted for the first one to two weeks and should not occur while under the influence of stronger pain medications.
Return to office work is often possible within four weeks, while more physically demanding jobs may require four to six weeks. Sexual activity is advised to be avoided for about three months after surgery. Light vaginal discharge, sometimes with a small amount of blood, can occur for several weeks, especially around 7-10 days post-surgery.
Potential Considerations and Long-Term Outlook
While sacrocolpopexy with hysterectomy is effective, it carries risks. General surgical risks include infection, bleeding, and adverse reactions to anesthesia. Specific complications can include injury to nearby organs, such as the bladder or bowel, during the operation.
Mesh-related issues are a particular consideration due to the synthetic material used for support. Although relatively rare, these can include mesh erosion, infection of the mesh, or persistent pain. There is also a possibility, though small, of the prolapse recurring over time.
Success rates for sacrocolpopexy in correcting prolapse are high, often providing lasting support. However, individual results can vary depending on factors such as the extent of the prolapse, overall health, and adherence to post-operative care instructions. Long-term follow-up care with the surgical team is important to monitor recovery and address any potential complications.