Colpopexy, Vaginal; Extra-Peritoneal Approach (Sacrospinous, Iliococcygeus)

Name of the Procedure

• Colpopexy, vaginal
• Sacrospinous colpopexy
• Iliococcygeus colpopexy

Summary

Colpopexy is a surgical procedure designed to provide support to the vaginal vault to correct pelvic organ prolapse. The extra-peritoneal approach means the surgery is performed without entering the peritoneal cavity, and it often involves attaching the vaginal vault to the sacrospinous ligament or iliococcygeus muscle.

Purpose

• To correct pelvic organ prolapse, where pelvic organs like the bladder, uterus, or rectum drop from their normal position.
• The goal is to restore normal pelvic anatomy and function.

Indications

• Symptoms of pelvic organ prolapse such as vaginal bulging, discomfort, urinary or bowel dysfunction.
• Patients with significant pelvic floor weakness not responding to conservative treatments.

Preparation

• Patients may be asked to fast for several hours before the procedure.
• Discontinue certain medications (e.g., blood thinners) as advised by the healthcare provider.
• Pre-operative assessments including pelvic examination, imaging tests, and sometimes urodynamic studies.

Procedure Description

1. The patient is placed under regional or general anesthesia.
2. A vaginal incision is made to access the pelvic structures.
3. The vaginal vault is elevated and sutured to the sacrospinous ligament or iliococcygeus muscle to provide support.
4. Surgical tools include sutures, retractors, and sometimes synthetic mesh.
5. The incision is closed with absorbable sutures.

Duration

Typically, the procedure takes about 1 to 2 hours.

Setting

The procedure is usually performed in a hospital or an outpatient surgical center.

Personnel

• Surgeons specializing in gynecology or urology
• Surgical nurses
• Anesthesiologists

Risks and Complications

• Common risks: bleeding, infection, pain.
• Rare risks: injury to nearby organs (bladder, bowel, ureters), deep vein thrombosis, urinary retention, recurrence of prolapse.
• Management includes antibiotics for infection, pain medication, and close monitoring.

Benefits

• Improved pelvic organ support.
• Relief from symptoms of prolapse.
• Enhanced quality of life.
• Benefits are typically realized within weeks following recovery.

Recovery

• Post-operative care includes pain management, avoiding heavy lifting, and limiting physical activity.
• Some patients may need a catheter for a short period.
• Recovery time is usually 4 to 6 weeks, with follow-up visits to monitor healing.

Alternatives

• Non-surgical options like pelvic floor exercises (Kegels), pessaries.
• Other surgical approaches such as abdominal colpopexy.
• Each option has its own pros and cons compared to vaginal colpopexy with an extra-peritoneal approach.

Patient Experience

• During the procedure: No sensation due to anesthesia.
• After the procedure: Mild to moderate pain at the surgical site, managed with pain medications.
• Patients may experience some vaginal discharge or spotting.
• Instructions for post-operative care to ensure a smooth recovery.