Dr. Cornella shares the surgical treatment options available for vaginal prolapse.
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Surgical Treatment Options for Vaginal Prolapse There are two primary routes for surgery in patients who exhibit prolapse. One of these is vaginal. Typically patients will be in the hospital overnight following vaginal surgery. The other route of surgery is minimally invasive laparoscopic or robotic surgery. Patients may do this as an outpatient or they may be in the hospital overnight. Typically the recovery rate for issues related to prolapse following surgery is a time period of three to six weeks. Patients may need a catheter for several days following surgery depending on the amount of relaxation, which was corrected at operation. One of the primary operations for vaginal vault prolapse has been sacral colpopexy. For years this was done through an open incision with the tenant morbidity of an open incision. Today we are able to do this minimally invasively through either laparoscopy or robotics. In robotic sacral colpopexy a thin mesh is attached to the vagina with the opposite end being attached to the area of the pre-sacrum. This results in very high cure rate in terms of apex decent of the vagina. It’s done minimally invasively and thus, the patient may go home the same day or the day following surgery. Laparoscopic management of prolapse as compared to open treatment of prolapse, in other words where an incision is made, offers a much better recovery rate with fewer issues related to morbidity. This may include wound infection in patients who are obese. One of the issues related to open incision in the obese patients was a risk of wound infection. Laparoscopy significantly reduces the risk of wound infection. At Mayo Clinic, Arizona we believe that synthetic mesh for vaginal prolapse should be used in limited situations. Mesh placed through the vagina may have a fairly high erosion rate as compared to mesh placed via the abdomen. Thus, we tend to utilize mesh primarily through robotics and specifically with the use of robotic sacral colpopexy for vaginal vault prolapse.