Hysteropexy versus Hysterectomy
Sacrohysteropexy is a surgical procedure to correct uterine prolapse. It involves a resuspension of the prolapsed uterus using a thin strip of synthetic mesh to lift the uterus and hold it in place. It allows for normal sexual function and preserves child bearing function.
The sacral colpopexy with or without a uterus in place is considered the most successful operation for the support of the vaginal vault or uterus and is routinely performed via an incision known as a laparotomy.
The laparoscopic sacral colpo hysteropexy is performed though the miniature incisions using a laparoscope and a small camera device to allow the surgeon to look at different tissues and organs inside the patients body without performing open surgery. The aim of laparoscopic hysteropexy is to restore and reinforce normal uterine support by suspending the uterus from the sacral promontory (tail bone) using polypropylene mesh. The mesh is strongly attached at two points: namely the uterus/cervix and the anterior longitudinal ligament over the sacral promontory. This is different than a trans vaginal mesh( TVM)
Hysteropexy restores the normal support of the vagina, suspending the uterus back in its anatomical position by reinforcing weakened ligaments with a mesh. This procedure allows the length of the vagina to be restored without compromising its calibre, and is therefore likely to have a favourable functional outcome.
Once the mesh is secured to the back of the uterus it is also secured to the sacrum using the same type of permanent suture used on the back of the uterus. The sutures don’t actually go into the bone of the sacrum,but instead attach to a ligament known as the presacral ligament on the bone.
After the mesh is secured to the sacrum, the mesh is covered with the peritoneal skin using an absorbable suture which helps to prevent intestines i.e. bowels from looping around the mesh and causing bowel obstruction later on.
Sacrohysteropexy can be performed as an open operation or laproscopically (via keyhole incisions). The advantages of laparoscopic approach include superior visualisation of the anatomy ,less time in hospital post operative,generally faster recovery times and less postoperative pain or complications.
The advantages of this operation over hysterectomy as well as preservation of fertility, is a stronger repair, with less risk of recurrent prolapse. Cuts to the vagina itself are also avoided so it is likely there is less risk of subsequent sexual problems.
- Laparoscopic = mini-incision in the belly
- Sacral = tailbone
- Colpo = vaginal vault (deepest point of vagina)
- Hystero or Utero = uterus
- Pexy = support
