An enhanced technique in performing minimally invasive pectopexy surgery to correct severe pelvic organ prolapse without having to remove the uterus has shown excellent results in the first patient to have undergone the procedure in South Africa.
“We recently performed the new procedure at Netcare Garden City Hospital, and I have heard that our patient, who is in her 40s, is doing very well. As there was no medical need to remove her uterus, we elected to perform the first pectopexy operation without an accompanying hysterectomy in South Africa,” says Dr Paul Blaauwhof, a gynaecologist who practises at Netcare Rosebank and Netcare Garden City hospitals.
Pelvic organ prolapse (POP) is a condition whereby the internal pelvic organs of a woman descend from their usual positions in the body as a result of the pelvic muscles and tendons no longer holding the organs in position. In severe cases, a bulge may be felt inside the vagina or the organs may even descend to such an extent that they protrude from the vagina.
Women who experience POP may have a predisposition to urinary tract infections because of residual urine remaining in the bladder. Other symptoms include a feeling of pressure or fullness in the pelvic area, pain during sexual intercourse, lower backache and a sensation of heaviness or pulling associated with the sagging organs.
Blaauwhof performed the first pectopexy procedure in South Africa two years ago. A pectopexy involves a laparoscopic procedure for supporting the internal organs with the aid of an intra-abdominal mesh, which is made of polyvinylidene fluoride (PVDF).
A number of the pectopexies Blaauwhof has performed involved the mesh being sutured to the stump of the uterus, which had been partially removed, in order to support the internal organs. With the new technique, however, the uterus can be completely preserved.
“Leaving the uterus intact is an option if there are no other foreseeable medical problems. We usually perform a pap smear beforehand, and if the result is normal it is possible, and often desirable, to preserve the uterus.
“Removal of the uterus can restrict blood flow to the ovaries, which can in turn compromise ovarian function and this may negatively impact hormone production – often resulting in earlier onset of menopause. With this enhanced pectopexy procedure, we are able to avoid this in patients who qualify for this option.
“In addition to less time under anaesthetic and reduced costs, this solution incurs less risk of surgical complications. For younger patients in particular, retaining the uterus means that their hormonal balance will usually not be affected,” Blaauwhof explains.
POP can be caused by a number of factors, including vaginal birth, obesity, asthma, hormonal changes and genetic factors weakening the tissues holding the internal organs in place.
“It can be corrected by supporting the uterus and other organs with the pectopexy procedure. A hysterectomy is a major operation, and can be damaging to the support of the bladder. This may lead to a higher chance of recurrence of POP because the bladder and neighbouring uterus share supporting tissues.