Vaginal Hysterectomy Repair

The Condition
The uterus (also known as the womb) is a pear shaped organ that sits between the bladder and the rectum (back passage).

The most common conditions of the uterus, for having a hysterectomy are:

  • Uterine disease
  • Diseases of tubes and ovaries
  • As part of the treatment for a prolapse
  • Bleeding not controlled by conservative treatment.

The Operation
Vaginal Hysterectomy
This is the removal of the uterus through the vagina. The vagina is stitched from below and there is no cut in the abdomen.

Laparoscopically-Assisted Vaginal Hysterectomy
Sometimes, a laparoscope (telescope type of instrument) is also used. If it is difficult to remove the uterus through the vagina or the tubes and/or ovaries need to be removed, the surgeon may start with a laparoscopy and then complete the operation through the vagina. The surgeon will discuss with you the best surgery for your condition.

Total Laparoscopic Hysterectomy
The hysterectomy with or without removal of tubes and/or ovaries is complete via a laparoscopic technique. This is more likely to be done if a prolapse repair is not required.

Vaginal Repair and Sacrospinous Colpopexy
Women needing hysterectomy often have other co-existing problems. These relate to prolapse of other organs into the vagina. These are prolapse of the bladder (cystocele), urethra (urethrocele), rectum (rectocele) and bowel (enterocele). Women may also have a weak perineal body (an attachment for the pelvic floor). This is usually related to birth trauma. These conditions will require repair at the same time as the hysterectomy.

The vaginal repair is done by ‘double breasting’ the tissues in the front and back walls of the vagina (vaginal repair). The vagina is often hitched up to a ligament at the back of the pelvis (sacrospinous colpopexy) to help reduce recurrence of the problem. Your doctor will discuss with you the most appropriate procedure for your condition.

Mesh repairs
Vaginal mesh for the repair of prolapse has gone out of favour due to an unacceptable level of complications. If mesh is required, this is done via a laparoscopic approach which is associated with fewer complications.

Due to the restoration of the pelvic organs back to their normal positions, this surgery may uncover hidden problem such as incontinence and overactive bladder. If there is a high suspicion that this may occur, your doctor will order urodynamic testing and consider doing incontinence surgery at the same time as your vaginal hysterectomy and repair. Pre- and post-surgery physiotherapy may be required. The most appropriate procedure will be discussed with you.

Benefits of having the surgery
The decision to have a hysterectomy depends on the type of problems you are having and how bad they are. It also depends on whether you need major surgery to make your life better or, if you have a life threatening illness, to prolong your life. You need to discuss this with your surgeon.

Risks of not having the procedure
This depends on the reason for the surgery: For prolonged bleeding, you may develop anaemia, which may need blood transfusions, and continued problems with heavy and irregular periods.

If you have a prolapse, the uterus can drop down into the vagina and even outside the vagina where it can develop ulcers and cause considerable pain and discomfort. If you have a suspected tumour, then possible spread of tumour may result.

Anaesthetic
Your anaesthetist will discuss the anaesthetic risks prior to your procedure.

General risks of a procedure
There are risks with any operation, and these risks can happen with a hysterectomy. They include:

    1. Small areas of the lungs may collapse, increasing the risk of chest infection. This may need antibiotics and physiotherapy.
    2. Clots in the legs with pain and swelling. Not infrequently, the clot may break off and go to the lungs which causes serious breathing troubles and can be fatal
    3. A heart attack because of strain on the heart or a stroke.
    4. Death is possible but very, very rare.