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Uterine Prolapse with Closed Method

What is vaginal prolapse?

After the uterus is removed, the vagina is held in place by the body's natural support structures. Vaginal prolapse is the condition where the vagina hangs from where it should be towards the vaginal opening as a result of weakening of these support structures.

Weakening of these support structures; It depends on whether the uterus was removed, age, changes in hormone levels, and the number of vaginal deliveries. Vaginal prolapse can affect quality of life. For example, it can cause a feeling of pelvic pressure and discomfort.

What is Laparoscopic Sacrocolpopexy?

Is there any alternative to this surgery?

Minor sagging can be treated without surgery with pelvic floor exercises and vaginally inserted pessaries (usually a plastic ring). Surgery may be needed if you have more serious sagging symptoms. Current operations for vaginal prolapse; meshed or non-mesh vaginal repair, sacrospinous fixation, and sacrocolpopexy (laparoscopic or open). Sacrospinous fixation (a vaginal procedure where the vagina is attached with sutures to the sacrospinous ligament) and sacrocolpopexy are the most effective surgeries.

What is the success rate of sacrocolpopexy surgery?

Studies have shown us that open abdominal sacrocolpopexy has a success rate of 74-98.8%, and laparoscopic sacrocolpopexy has a success rate of around 92%.

Because laparoscopic surgeries are newer than open abdominal surgeries, less is known about how successful laparoscopy is in the long run.

What are the risks that may occur during or after the surgery?

No procedure is risk-free in surgical procedures, and complications can sometimes occur. These include:

The serious risks of laparoscopy are as follows

  • The overall risk of serious complications from diagnostic laparoscopy is approximately two women in 1,000 (rare).
  • Injury of the bowel, bladder, ureters (tubes that carry urine from the kidneys to the bladder) or large vessels that require immediate repair by laparoscopy or laparotomy (open surgery) (rare). However, up to 15% of bowel injuries may go undiagnosed during laparoscopy.
  • Inability to enter the abdominal cavity and perform the surgery
  • Hernias from incisions
  • Deep vein thrombosis
  • Death (3 to 8 women out of 100,000) (very rare)

The following are common risks during laparoscopy

  • bruising at the incision site
  • Shoulder pain
  • Opening the incision site
  • Infection at the incision site

Extra procedure required during surgery

  • Laparotomy
  • Repair of damage to the bowel, bladder, ureter or vessels
  • Blood transfusion

Risks of Sacrocolpopexy

  • Prolapse that occurs in another part of the vagina after surgery, which requires surgical correction, is seen between 1 and 3 in 10 women.
  • The development or worsening of urinary incontinence symptoms, including stress incontinence or overactive bladder, occurs in about 1 in 10 women.
  • Damage to surrounding organs occurs in 5 out of every 100 women.
  • Intestinal obstruction occurs in 2 out of every 100 women.
  • Approximately 5 out of 100 women have the mesh being rejected by the body and the edges of the mesh extending into the vagina. In this case, the extending crotch can be removed and may rarely need to be completely removed.
  • Mesh infection
  • Pain during sexual intercourse
  • Pelvic infection and abscess formation
  • Bone infection (rare)

Prevention of blood coagulation

Without preventive measures, the risk of developing a blood clot in the leg (deep vein thrombosis or DVT) in all surgical patients is approximately 15-25%. Please discuss the risks of this operation with your surgeon. Additional information will be provided about the measures we have taken to reduce this risk.

What kind of anesthesia will be used in the surgery?

The operation will be performed under general anesthesia. You will sleep and feel nothing. Before the operation, you will meet the anesthetist and have the chance to ask your questions about anesthesia.

Prevention of Infection

A dose of antibiotics will be given during the operation to reduce the risk of infection (prophylactic antibiotics). Other doses of antibiotics may be given before discharge.

What to expect after surgery?

When you wake up after surgery, you will have a cannula (small plastic tube in a vein) in your hand or arm. You may have a catheter (draining tube) in your bladder and a gauze pack (like a large tampon) in your vagina. This is more likely if you have had vaginal surgery to correct the prolapse along with laparoscopic sacrocolpopexy. If you have a catheter and/or a vaginal tampon, the tampon is usually removed the day after surgery. There will be dissolving stitches and a dressing on the small incisions in the abdomen.

There may be some discomfort, but not severe. Nurses will give you pain medication. Some women may experience bloating and shoulder pain due to gas under the respiratory muscle (diaphragm). This feeling disappears as the gas is absorbed by the body. You will be discharged 24-48 hours after the surgery.

Discharged

If you have had vaginal surgery with laparoscopic sacrocolpopexy, you will have some vaginal discharge that can last up to 6 weeks and vary in color and amount. Hygienic towels should be used instead of tampons for discharge. If the discharge turns into bleeding or has a heavy and offensive odor, you should consult your doctor.

The recovery time is usually 3 to 4 weeks. In the beginning, you should avoid strenuous and heavy work and gradually return to your normal life. Swimming is a good exercise after recovery.

Women have a risk of developing constipation after gynecological surgeries. Make sure you drink plenty of fluids and eat a balanced diet, including fruits and vegetables. You may need to be given laxative drugs after constipation.

In the beginning, sexual intercourse can be a little uncomfortable and should be avoided during the recovery period as it can disrupt the healing process. It will be useful to use vaginal lubricant products at first. Post-operative patients often find that sexual intercourse is more enjoyable than before they had prolapse surgery. Most patients can return to work after 4 to 6 weeks, depending on the type of work.

You should avoid driving for 2-4 weeks. When you do not feel pain after emergency braking, you can start driving. Practice stopping and reversing in the car before you start driving.

Pelvic floor muscles; It provides important support for your vaginal walls, bladder and bowels. It is important for controlling bowel and bladder function.

Either lie on your back with your knees bent or sit in a sturdy chair with your knees slightly apart in good posture.

Squeeze the ring of muscle around the anus as if inhibiting bowel movement, and then Squeeze the muscles around your anterior passages, lift them up, HOLD, and then slowly release. Don't forget to relax your hip and thigh muscles. Breathe normally throughout the exercise.

Exercise schedule

Aim to exercise as described 3 times a day.

  • Slow hold: Gradually increase your pelvic floor muscles until you can hold them for a maximum of 10 seconds and aim for 10 repetitions.
  • Quick tighten: Now quickly tighten your pelvic floor muscles and then relax the muscles completely. Your goal should be 10 quick spins.
  • Do both of these exercises while sitting, and then start standing. Your goal is for these exercises to become a lifelong habit to maintain support for your bladder.

Consult your doctor in case of any of these conditions after surgery

  • Severe pain
  • Fever
  • Excessive bleeding
  • Bad smelling discharge
  • If one of your legs is painful, hot, red or swollen, this may be a symptom of deep vein thrombosis (blood clot).
  • An unexplained shortness of breath, chest pain and/or coughing up blood may indicate a pulmonary embolism (blood clot in the lung).
  • Dissatisfaction with the results of the surgery

Approximately 6-8 weeks after the surgery, you will be given an appointment for control. If you or your doctor think it is necessary in any situation that you see differently or that bothers you, you can apply to the polyclinic before the appointment date.

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