57283 Colpopexy, vaginal; intra-peritoneal approach (uterosacral, levator myorrhaphy)

Name of the Procedure:

Colpopexy, Vaginal; Intra-Peritoneal Approach (Uterosacral, Levator Myorrhaphy)

Summary

Colpopexy is a surgical procedure used to repair pelvic organ prolapse, where the pelvic organs descend into or outside of the vaginal canal. The intra-peritoneal approach involves repositioning and securing these organs using the uterosacral ligaments and levator muscles via a vaginal route.

Purpose

The procedure addresses pelvic organ prolapse, which can cause discomfort, urinary and bowel issues, and other complications. The goal of colpopexy is to restore normal support to the pelvic organs, alleviate symptoms, and improve quality of life.

Indications

• Pelvic organ prolapse (uterine prolapse, vaginal vault prolapse, etc.)
• Symptoms such as pelvic pressure, urinary incontinence, or difficulty with bowel movements
• Failure of non-surgical treatments (e.g., pessaries, pelvic floor exercises)

Preparation

• Patients may need to fast for several hours before the procedure
• Adjustments to medications as advised by the healthcare provider
• Pre-operative diagnostic tests such as pelvic exams, imaging studies (ultrasound, MRI), and possibly urodynamic testing

Procedure Description

1. The patient is positioned, and general or regional anesthesia is administered.
2. A vaginal incision is made to access the prolapsed organs.
3. The uterus or vaginal apex is lifted, and the uterosacral ligaments are identified.
4. Sutures are placed through these ligaments and may be attached to other supportive structures like the levator muscles, securing the prolapsed organs in their normal position.
5. The incisions are closed, and the area is checked for proper positioning and hemostasis.

Tools, Equipment, and Technology:

• Surgical sutures and instruments (scalpel, forceps, needle holders)
• Vaginal retractors and possibly laparoscopic equipment

Anesthesia:

• General anesthesia or regional anesthesia (spinal or epidural)

Duration

The procedure typically takes about 1 to 2 hours.

Setting

Colpopexy is usually performed in a hospital or a surgical center.

Personnel

• Surgeon (Gynecologist or Urogynecologist)
• Anesthesiologist
• Surgical nurses
• Surgical technicians

Risks and Complications

• Common: Pain, infection, bleeding, urinary retention
• Rare: Damage to surrounding organs (bladder, bowel), deep vein thrombosis, recurrence of prolapse

Management of complications includes antibiotics for infections, pain relievers for discomfort, and further surgical intervention if needed.

Benefits

• Relief from symptoms like pelvic pressure, urinary incontinence, and bowel issues
• Improved pelvic organ support
• Enhanced quality of life
• Benefits may be realized shortly after recovery, though complete healing takes several weeks.

Recovery

• Post-procedure care includes pain management and instructions for wound care.
• Avoid heavy lifting, strenuous activities, and sexual intercourse for about 6 weeks.
• Follow-up appointments for monitoring recovery and ensuring proper healing are necessary.
• Full recovery typically takes 6 to 8 weeks.

Alternatives

• Non-surgical options: Pessary devices, pelvic floor physical therapy
• Other surgical options: Sacrocolpopexy, transvaginal mesh surgery
• Pros and cons depend on individual conditions and preferences; non-surgical options are less invasive, but may be less effective long-term.

Patient Experience

• During the procedure: The patient will be under anesthesia and should not feel pain.
• After the procedure: Expect mild to moderate pain managed with prescribed medications, possibly some vaginal discharge or spotting. The patient might feel sore and experience temporary limitations on activities. Comfort measures like rest and following post-care instructions are essential for a smooth recovery.