Sacrohysteropexy:


Sacrohysteropexy is a surgical procedure aimed at correcting uterine prolapse while preserving the uterus. It involves supporting the uterus by attaching it to the sacrum using a mesh or other supportive materials. Here's an overview of the procedure:


Indications:

  • Uterine Prolapse: Particularly when the patient wishes to retain her uterus for future fertility, hormonal benefits, or personal reasons.

  • Mild to Moderate Prolapse: Where conservative treatments like pelvic floor exercises, pessaries, or lifestyle changes have not been effective.

  • Younger Patients: Who might desire future pregnancies or are not ready for hysterectomy due to age or other health considerations.

  • Recurrent Prolapse: After previous treatments or surgeries where the uterus was not removed.

  • Symptomatic Prolapse: When the prolapse causes significant symptoms like pelvic pressure, incontinence, or sexual dysfunction.


Techniques:

  1. Open Sacrohysteropexy:

    • Description: An abdominal incision allows direct access to the pelvic cavity. Mesh is sutured from the uterus to the sacrum, providing support.

    • Advantages: Direct visualization for precise mesh placement.

    • Disadvantages: Involves a larger incision, longer recovery, and higher risk of postoperative complications like infections.

  2. Laparoscopic Sacrohysteropexy:

    • Description: Utilizes small incisions through which a laparoscope and surgical instruments are inserted. The mesh is attached similarly but through minimally invasive means.

    • Advantages: Reduced pain, faster recovery, smaller scars, and lower risk of wound-related complications.

    • Disadvantages: Requires specialized training, potentially longer operative time compared to open surgery.

  3. Robotic Sacrohysteropexy:

    • Description: Similar to the laparoscopic approach but with the aid of a robotic system for enhanced precision and control.

    • Advantages: Offers benefits of laparoscopy with potentially better precision in mesh placement, 3D visualization, and less surgeon fatigue.

    • Disadvantages: The high cost of equipment and limited availability.


Procedure Details:


  • Preparation: Preoperative assessment includes imaging to understand the degree of prolapse and discussions regarding fertility preservation.

  • Mesh Application: The mesh or graft material is typically Y-shaped, with one arm attached to the anterior cervix and the other to the posterior cervix, then extending to the sacrum.

  • Fixation: The mesh is secured to the sacral promontory, often with sutures or tacks, ensuring the uterus is supported in its normal anatomical position.


Postoperative Care:


  • Monitoring for complications like infection, mesh erosion, or recurrence.

  • Patients are advised on pelvic floor exercises to strengthen support structures.

  • Follow-up appointments to assess the success of the surgery and any signs of prolapse recurrence.


Sacrohysteropexy offers an alternative to hysterectomy for those with uterine prolapse who wish to keep their uterus. However, like any surgical intervention, it involves risks such as mesh-related issues or the possibility of needing further surgery if the prolapse recurs. Patient selection, informed consent, and thorough preoperative discussions are vital to the success of this procedure.