Laparoscopic Sacrocolpopexy for Vault Repair

Sacrocolpopexy:

In this abdominal route operation, the surgeon utilises a mesh to suspend the vaginal vault from the anterior longitudinal ligament over the sacrum. It has a relatively high success rate of around 90 per cent for the amendment of vaginal vault prolapse, nevertheless around is a small risk of mesh erosion. It can be performed as an ‘open’ procedure or laparoscopically.

Colposuspension:

This used to be considered the ‘gold standard’ surgery for treating urodynamic stress incontinence and supporting the anterior vaginal wall. Its role has diminished with the advent of the newer anti-incontinence operations (TVT, TOT). Nevertheless, it remains an option for treating urinary incontinence associated with severe cysto-urethrocoele, and for women requiring other surgical procedures by the abdominal route.

Female genitourinary prolapse is a common gynecological disorder with varying severity. Women often have vaginal result with a combination of other symptoms (for example, urine, feces and sex). Surgery is the main treatment, but the pathogenesis is not understood. Prolapse is defined as a protrusion of organs or structures above normal anatomical boundaries. The term agreed the most suitable international female urogenital prolapse is female pelvic organ prolapse sex (POP). Recent demographic studies have shown that the prevalence of any degree of POP in women varies around the age of 20 years and 54 years is 31 percent, two percent were considered serious enough to warrant surgical treatment of prolapse, In addition, it is estimated that every woman has a lifetime risk 11 percent suffer an operation prolapse and incontinence.

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The nation's Institute for Health and Clinical Excellence (NICE) has issued full guidance towards the NHS in England, Wales, Scotland and Northern Ireland on sacrocolpopexy using mesh for vaginal vault prolapse repair. It replaces the previous guidance on mesh sacrocolpopexy for vaginal vault prolapse. NICE was notified of various procedures for that treatment of pelvic organ prolapse.

NICE asked the Review Body for Interventional Procedures to undertake an organized review of these procedures.The Interventional Procedures Advisory Committee (IPAC) considered the systematic review and have also produced guidance on: sacrocolpopexy using mesh for uterine prolapse repair, infracoccygeal sacropexy using mesh for vaginal vault prolapse repair, infracoccygeal sacropexy using mesh for uterine prolapse repair and insertion of uterine suspension sling (including sacrohysteropexy) using mesh for uterine prolapse repair.

Vaginal vault prolapse occurs when organs above or round the vagina slip down from their normal position. Sacrocolpopexy is definitely an operation that aims to supply support for the pelvic organs within their natural position. This is done by attaching a bit of material (mesh), usually in the top and back from the vagina, to a ligament from the lower back bone.

Postoperative Care

Patients who have undergone surgery for vaginal prolapse are usually advised to avoid lifting heavy objects, or any other situations that might cause sustained increases in abdominal pressure. Perioperative use of laxatives is often recommended in order to prevent constipation. The immediate perioperative care usually involves prophylactic intraoperative antibiotics to reduce the risk of infection, a vaginal pack to reduce the risk of bleeding and vaginal haematoma, and a urinary catheter to avoid the risk of urinary retention. These are usually removed the day after surgery.

Conclusion

Female genitourinary prolapse is a common gynaecological problem that is often associated with urinary and bowel symptoms and pelvic discomfort. Surgery is the mainstay treatment, but recurrence following surgery remains a problem, and long-term outcomes and complications of several techniques are unvisible. Conventional treatment options such as the use of vaginal ring or shelf pessaries should be made available to women previously before surgical treatment.

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