Pelvic Reconstructive Surgery

Pelvic reconstructive surgery is an intervention used to treat pelvic organ prolapse in cases where nonsurgical alternatives such as kegel exercises, biofeedback therapy, and using a pessary have failed. A pelvic organ prolapse occurs when, as a result of the pelvic floor weakening, the bladder, uterus, vagina, and rectum drop below their normal positions. The condition normally occurs following childbirth, but can also be caused by chronic disease, heavy lifting, or surgery.

The Nature of Reconstructive Surgery

The goals of reconstructive surgery are twofold. It aims both to repair the pelvic floor and to return the prolapsed organs to their original positions. This form of surgery necessitates that an abdominal incision is made either by way of a laparoscopic colposuspension or by an open abdominal colposuspension.

In contrast to a laparoscopic colposuspension, which is a minimally-invasive keyhole technique, an open abdominal colposuspension requires that either a conspicuous lower-middle incision or, an equally conspicuous, Pfannenstiel incision is made in the abdomen.

Given that pelvic organ prolapse can affect people in different ways, there are a number of different reconstructive surgeries that can be performed. These include;

• Sacrospinous Ligament FIxation and Uterosacral Ligament Suspension

Both of these procedures seek to provide improved support to the uterus or the vaginal vault. In the case of a sacrospinous ligament fixation, this is achieved by using the sacrospinous ligament to suspend the vagina. On the other hand, a uterosacral ligament suspension requires that an overstretched uterosacral ligament is shortened.

• Colporrhaphy

A colporrhaphy can be performed to correct either a prolapsed bladder, known as a cystocele or a prolapsed rectum, known as a rectocele. In both instances, the goal of the procedure is to tighten and strengthen the tissue that holds the pelvic organs in place.

• Sacrocolpopexy and Sacrohysteropexy

These procedures both use surgical mesh to repair and secure pelvic organs. More specifically, a sacrocolpopexy is used to treat a prolapsed vaginal vault, while a sacrohysteropexy is a surgical response to a prolapsed uterus.

Risks

Reconstructive surgery is no different from any other form of surgery in that it entails a number of risks. In this instance, these risks include; bleeding, infection, organ injury, and both urinary retention and urinary incontinence.

After Surgery

Following surgery patients should expect to take several weeks off work. Similarly, for the first 6 weeks after surgery, it’s recommended that patients avoid vigorous exercise and sex. In the longer run, recovery can be facilitated by improving both posture and diet and by performing pelvic bracing and kegel exercises.