Pelvic Prolapse and Laparoscopic Enterocele and Cystocele Repair

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Pelvic Prolapse and Laparoscopic Enterocele and Cystocele Repair

Pelvic Prolapse and Laparoscopic Enterocele and Cystocele Repair

Pelvic Prolapse is when pelvic supporting tissues have torn away from their normal attachments and pelvic organs fall down. The traditional approach to this problem has been vaginal surgery where the vaginal walls are opened and the supporting tissues (fascia) are sewn together with absorbable sutures. Pelvic prolapse can also be managed by laparoscopy. Through a laparoscope the space between the bladder and pubic bone is opened and using permanent suture the pubocervical fascia (supporting tissue between the bladder and vagina) is reattached to the fascial line along the medial surface of the Obturator Internus muscle (lateral sidewall of the retropubic space).

When a uterus is present, then all the supporting tissues attach around the cervix. When a uterus has been removed, then the supporting tissues (fascia) from between the bladder and the vagina (pubocervical fascia) should be reattached to the supporting tissues between the rectum and the vagina (rectovaginal septum) at the top of the vagina, and these supports should also be attached to the uterosacral ligaments. We know that enteroceles (top of the vagina falling down) are due to the absence of supporting tissues (fascia) at the top of the vagina. Using the laparoscope these spaces are opened and using permanent sutures, with or without mesh, the pelvic supports are reconstructed. This provides a more definitive, longer lasting, and anatomically correct repair of enteroceles and vaginal vault prolapse. 

When the uterus and cervix are surgically absent and there is only a vaginal cuff, the best treatment for apical prolapse is sacro-colpopexy with mesh. 

When only the cervix is present or following a laparoscopic supracervical hysterrectomy, the best tratment for apical prolapse is sacro-cervicopexy with mesh. 

Click here to learn more about Pelvic Prolapse and Laparoscopic Enterocele and Cystocele Repair and view surgery photos.

If you're ready to get started, or if you have any questions, please call the office at (207) 883-3883 or send us a message, we'd love to hear from you.

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