Abdominal Sacropolpopexy

It is an operation performed from the abdomen to support the vagina to the ligament on the spine (after previous or concurrent surgery to remove the womb) by using a synthetic mesh.

Why Is It Performed?

It is performed to treat severe protrusion of the vagina after removal of the womb.

The protrusion usually bothers you because of:

• An uncomfortable lump
• Urinary difficulties (e.g. incomplete emptying of the bladder)
• Bowel difficulties (e.g. constipation, incomplete emptying of bowels)
• Pain
• Infection
• Bleeding

The objective of the operation is to relieve your symptoms, restore vaginal anatomy (as much as possible) and sexual function.

What Are The Risks Associated With Sacrocolpopexy?

Sacrocolpopexy is a relatively safe operation in good hands. However, like all surgical operations, complications may occasionally occur. These include:

• Bleeding
• Infection
• Injury to surrounding organs (e.g. nerve or blood vessels, ureter, bladder & intestines)
• Formation of blood clot in the legs or lungs
• Recurrence of vaginal prolapse
• Slow return of bowel or bladder function
• Erosion of synthetic material through vaginal mucosa

What Happens Before The Surgery?

1. Blood tests, electrocardiography (ECG) and chest X-ray may be done to ensure that you are in optimal health for surgery.
2. Your doctor may prescribe oral or vaginal oestrogen (hormone) if you are already menopausal. It is important to comply with this medication as it ensures that your vaginal tissues are optimal for surgery and healing.
3. You will generally be admitted one day before your surgery.
4. You will be given preparations to clear your bowels and have the pubic area shaved.
5. You are not allowed to eat or drink after midnight on the day before surgery.
6. All your medical and surgical conditions, if any, must be made known to the doctor and must be optimally controlled.
7. If you are on aspirin, please inform your doctor. You must stop taking aspirin at least a week before surgery.

What Happens In The Operating Theatre?

The surgery is done under general anaesthesia. The anaesthetist will discuss with you the advantages and disadvantages of both methods.

An abdominal incision is made. The synthetic mesh is stitched to the posterior surface of the vagina and to the ligaments in front of the spine.

A tube/drain may be inserted into the abdomen to monitor the bleeding.

A catheter will be inserted into the bladder as there may be difficulty in urination immediately after the procedure.

Painkillers, laxatives and antibiotics would generally be prescribed after the procedure.

What Happens After The Surgery?

1. Immediately after the operation, you may experience:
   • Tiredness - You should rest and gradually increase your mobilisation until you feel fit to return to your normal activities.
   • Discomfort - In the lower part of the abdomen, over the incision. This is to be expected and painkillers should help to relieve the discomfort.
   • Vaginal bleeding - Mild to moderate amount of reddish watery discharge after surgery is quite normal and may last up to 3 weeks. You may want to wear a protective sanitary pad (not a tampon) during this period.
2. One day after surgery, you will usually be allowed to drink and eat. You are encouraged to move around. Blood investigations may be done.
3. The catheter is usually removed on the day after surgery. The drain is usually removed two days after the operation.
4. You may be discharged on the third or fourth day after surgery if you are well.
5. You should refrain from:
   • Strenuous exercise for 2 months. You may return to normal activity after that, or upon clearance by your doctor.
   • Using tampons, douching, sexual intercourse and driving for 4 weeks.
   • Carrying heavy weights (>5kg) in the long run.
6. You should return immediately to the Urogynaecology Centre (during office hours) or the KK 24-hour Women's Clinic if you have:
   • Heavy vaginal bleeding
   • Foul smelling vaginal discharge
   • Severe abdominal distension and / or pain not relieved by painkillers
   • High fever
   • Pain associated with passing urine
   • Difficulty in passing urine
   • Constipation

Follow-Up Visits

You will be reviewed at the Urogynaecology Centre at 1 week, 1-month, 6-month, 12-month and yearly reviews thereafter. It is important to keep your follow-up appointments to ensure the best possible results.