- How common is pelvic organ prolapse ?
It is quite a common condition seen mostly postmenopausal women and sometimes in young women. The patient has feeling of something coming out per vaginum and sometimes urinary incontinence or bowel complaints.
- Is vaginal surgery better than laparoscopy for prolapse ?
Laparoscopy has yielded better results than vaginal surgery. It has been proved that prolapse is due break in tissue collagen and not due to laxity of tissues. So plication surgery as done in vaginal surgery is an outdated concept. The chances of having recurrent prolapse, failure of procedure, vault prolapse is much much lesser with laparoscopy.
- People say that vaginal surgery is scar less surgery ?
I agree to that. Pain associated with vaginal surgery, hospital admission duration is much more. Patient recovery is also not faster as compared to laparoscopy. The small wounds of laparoscopy heal beautifully and become less and less visible with passage of time.
- Is mesh repair for prolapse better ?
As it has been proved that prolapse is due to tissue collagen breakage, mesh repair is better for prolapse (just as the concept for hernia surgery). Cystocele, rectocele correction is better. Placing mesh through vaginal route is associated with complications such as mesh erosion, infections so placing mesh laparoscopically is a much better and safer option.
- How can laparoscopy help in young patients with prolapse ?
Laparoscopic prolapse surgery with mesh is the procedure of choice in young patients who want to conserve the uterus. Patient can safely undergo pregnancy after this surgery.
- What is the role of laparoscopy surgery in patients having vault prolapse after vaginal hysterectomy ?
Vaginal Hysterectomy involves plication of tissues. So vault prolapse can occur after that as it doesnot correct the underlying inheretent weakness or collagen breakage. So the gold standard procedure is Laparoscopic Sacro colpo pexy using soft mesh.