Dr Jo Schoeman
Urological Surgeon

        

Vault Repair (Sacro-Colpo Pexy)

Product Summary: AMA rates

Repair of a vault of vagina prolapse. Either open or laparoscopic

Item number: 35597, 105

Why is it done?

  • The aim of surgery is to relieve the symptoms of vaginal bulge and/or laxity • Improve bladder function without interfering with sexual function.
  • Used where own natural tissue is too weak to use.
  • Vaginal prolapse is a common condition causing symptoms such as a sensation of dragging or fullness in the vagina, and difficulty emptying the bowel or bladder and back ache.
  • About 1 in 10 women need surgery for prolapse of the uterus or vagina.

Pre-requirements

  • An informed consent is required from the patient and a pre-admission clinic will be arranged.
  • Patients may not eat or drink from midnight the previous evening.
  • Patients are to refrain from smoking before the procedure.
  • Patients allergic to IODINE / CHLORHEXIDINE should clearly state this at the pre-admission clinic as well as to theatre staff and Dr Schoeman.
  • Any anti-coagulants such as Warfarin or Aspirin must be stopped 7 days prior to surgery. This may be replaced by once daily Clexane injections.
  • Pre-operative blood tests are required 4 days prior to surgery.
  • Patients with cardiac illnesses require a cardiologist/ physician report.
  • A chest X-ray is required for patients with lung disease.
  • Be prepared for an 2-3 day stay.

How is it done?

  • This procedure is done under a spinal / general anaesthetic, as decided by the anaesthetist.
  • Sacrocolpopexy is performed either through an abdominal incision or ‘keyholes’ (using a laparoscope or with a surgical robot), under general anesthesia.
  • The vagina is first freed from the bladder at the front and the rectum at the back.
  • A graft made of permanent synthetic mesh is used to cover the front and the back surfaces of the vagina.
  • The mesh is then attached to the sacrum (tail bone)
  • The mesh is then covered by a layer of peritoneum that lines the abdominal cavity; this prevents the bowel from getting stuck to the mesh.
  • Sacrocolpopexy can be performed at the same time as surgery for incontinence or vaginal repair for bladder or bowel prolapse.
  • A pelvic drain is left post-operatively.
  • A cystoscopy may be performed to confirm that the appearance inside the bladder is normal and that no injury to the bladder or ureters has occurred during surgery.
  • A pack may be placed into the vagina and a catheter into the bladder at the end of surgery.
  • If so, this is usually removed after 3-48 hours. The pack acts like a compression bandage to reduce vaginal bleeding and bruising after surgery.

What to expect after the procedure?

  • When you wake up from the anesthetics you will have a drip to give you fluids and may have a catheter in your bladder.
  • The surgeon may have placed a pack inside the vagina to reduce any bleeding into the tissues.
  • You will have a surgical drain until the drainage is less than 20ml / 24hours.
  • Both the pack and the catheter are usually removed within 48 hours of the operation.

How successful is this surgery?

  • Studies show that 80 to 90% of women having sacrocolpopexy are cured of their prolapse and prolapse symptoms.
  • Following surgery there is a small risk of prolapse developing in another part of the vagina, such as the front wall that supports the bladder.
  • If this does develop it may require further surgery.

Complications?

  • Pain (generally or during intercourse) in 2-3%.
  • Exposure of the mesh in the vagina in 2-3%.
  • Damage to bladder, bowel or ureters in 1-2%.
  • There are also general risks associated with surgery:
    • Wound infection.
    • Urinary tract infection.
    • Bleeding requiring a blood transfusion.
    • Deep vein thrombosis (clots) in the legs.
    • Chest infection.

Vault Repair (Sacro-Colpo Pexy) Vault Repair (Sacro-Colpo Pexy) (358 KB)