Performed for pain in lower abdomen or for something coming out Per vagina or passing of urine on straining (coughing, weight lifting etc.)
Incidence of vault prolapse seems to have been increased following non-descent vaginal hysterectomy and abdominal hysterectomy in last few years because of overall life expectancy of all females has increased and today woman desires better quality of life after 60s of her age. More than 50% patients discloses the fact that she passing urine on coughing or laughing in patients along with vault prolapse and she wants relief for this distressing and long standing symptom since many years.
Vault prolapse is found to be associated with multiple pelvic floor defects and this can be better identified laparoscopically and addressed appropriately & anatomically. Addressing anterior, mid and posterior compartment defects repair from below may be inadequate and may leads to recurrent vault prolapse after vaginal repair. Today concept of identifying defects in pelvic endo-pelvic fascia and offering mesh support for adequate repair has become popular for better results. These multiple pelvic defects are identified and Anterior or mid or Posterior compartment defects repair are done systemically to prevent recurrence. Vaginal vault can be fixed with mesh and then mesh with sacral promontory with tacker. This surgery requires lot of experience & expertise.
PID, Tuberculosis, Endometriosis & post surgeries are the commonest causes of adhesions found around pelvic genital organs and anterior abdominal wall causing pain in lower abdomen along with prolapse. Post Laparotomy & post vaginal hysterectomy, adhesions are found in 20-70% of cases following various Gynecological surgeries leading to subsequent adhesions & post operative pain requiring Laparoscopic Adhesiolysis. Fact may inspire all patients to ask primary surgeon for not offering initial Gynaec surgery by Laparoscopic approach. Adhesiolysis is the most rewarding surgery in pain relief.
Benefits of Laparoscopy Surgery:
- Shorter Hospital stay,
- Earlier return to your routine work,
- Cosmetically vary small scar,
- Less pain after operation,
- Best fertility enhancement & Fertility results following Laparoscopy,
- Video-live operative file available in CD/DVD for future reference (Transparency about surgical procedure).
- The possibility of post-operative adhesion formation will be less, and the possibility of pain because of post-operative adhesions will also be less.
- Special advantages of laparoscopic Vault repair are:
- Better pain relief after operation,
- Less chances of redo surgery for vault prolapse again,
- Comprehensive and anatomical repair of multiple pelvic floor defects repair well
- Finally better sexual quality because of good vaginal depth after laparoscopic repair.
Pre-operative Check Lists:
- Lab. Investigation for Surgery (Urine complete & Blood complete, HbsAg, HIV, R.B.S.) Pelvic Trance vaginal USG report
- Specific Investigations for associated problems.
- Operation planned after good vaginal mucosa support by estrogen application for at least 7 days & prolapse reduction protocols before planning surgery.
Two days of liquid diet before operation and Special Peglac / Colon-wash
(Powder dissolved in one litre of drinking water and patient is asked to drink every 10 minutes till the same colored fluid comes out instead of stool) six hours prior to operation & preparation/shaving of local parts.
No. Of Cuts on Abdomen:
Three cuts: all of 5 mm size.
Average Stay in Hospital:
12-24 hours. (DAY CARE SURGERY)
Average Duration of Surgery:
Average Blood loss during Surgery:
Average time after operation to resume normal activities/work:
Within 24 hours.
General Anesthesia (Patient will not feel any pain in Operation Theatre during surgery)
Inside the Umbilicus small needle is introduced and Co2 gas is insufflated inside abdomen. Rather than creating a large incision and opening up the body, tiny incisions are made and a laparoscope is inserted. This slim scope has a lighted end. It takes pictures – actually fiber optic images - and sends them to a monitor so the surgeon can see what is going on inside.
Performing laparoscopy usually only requires three tiny incisions less than one half inch, (about 5-10 millimeters) in length. With previous midline scar on abdomen, we generally introduce verres needle through palmer’s point and then first 5 mm port is introduced through Palmer’s point. . This allows the surgeon a better view and more working space to maneuver the laparoscope and surgical tools as needed. Using small incisions rather than opening the abdomen lessens recovery time as well as discomfort and makes surgical scars less noticeable. With help of palmer’s point port, second 5 mm port is kept supra umbilically on vision above the midline intra abdominal midline adhesions. Third port is kept on Rt side near anterior superior iliac spine on vision. Adhesiolysis is done with Bipolar & scissor and adhesions are stretched from one side simultaneously Vaginal stent is pushed from below. Peritoneum near the bladder is identified and Bladder is dissected down and laterally. Posteriorly rectum is dissected down to expose posterior vaginal wall till pelvic floor. Peritoneum is opened on pelvic brim and peritoneum is dissected down, medial to Rt. Uterosacral ligament, away to RT Ureter till Rt vaginal apex below. Lower two ends of the mesh is sutured with anterior and posterior wall vaginal walls by No.1 Vicryl stitches and proximal mesh end is fixed with sacral promontory with tacker (small screw fixes with sacral promontory) Peritoneal closure started with Lt. Angle with No. 1 Vicryl by continuous closure and mesh totally covered with peritoneum.
Most of the time many patients undergo laparoscopy as Day care procedure, returning home within 24 hours of surgery. For normal laparoscopy procedure takes about 15 to 35 minutes only. For more complicated case it may take 1-2 hour. Most begin feeling much better within one day.
- Patient remains drowsy/sedated for 2-3 hours after laparoscopy but conscious & pain free.
- Patient can take fluids 6-8 hours after laparoscopy & light food after 8-10 hours.
- She may feel little abdominal & shoulder pain after laparoscopy for 24 hours but it cam be relived with pain killer tabs.
- Most of the patients can walk normally without support and can take normal diet 12hours after the laparoscopy.
- Folly’ss catheter is removed on next day.
- She can be discharged on the next day of the operation.
- Few patients may feel nausea & vomiting after laparoscopy, which can be very well controlled with injection in post-operative room.
- Patient can do her normal activity within 24 hours after laparoscopy. Patient is advised to take antibiotics & analgesic tabs. for 5 days following laparoscopy.
- Patient is advised to report to doctor for severe pain or bleeding or fever in postoperative period (Day-1 to Day-5) immediately.
- Patient is advised to come for follow up 7 days after the Laparoscopy for dressing.