Sacrospinous Fixation Operation

Transcription

1 Sacrospinous Fixation Operation Information for patients Gynaecology Department Phone no: East Cheshire NHS Trust Ref: Review: 10/2015 Sacrospinous Fixation Operation ref: Review: 10/2015 Page: 1

2 Introduction We advise you to take your time to read this leaflet and make a note of any questions you may have so that we can discuss them with you at our next meeting. It is your right to know about the operations being proposed, why they are being proposed, what alternatives there are and what the risks are. This leaflet firstly describes what prolapse is, it then goes on to describe the treatments available in our trust, how the operation will be performed, the risks involved in surgery and finally any alternative treatments you may wish to consider. What is prolapse? This condition refers to the bulging of one or more pelvic organs into or out of the vagina. The pelvic organs consist of the uterus (womb), vagina, bowel and bladder. Pelvic organ prolapse occurs when the muscles, ligaments and fascia (a network of supporting tissue) that hold these organs in their correct positions become weakened. Prolapse of the vagina or uterus is a common condition with up to 11% of women requiring surgery during their lifetimes. A vaginal vault (the top of the vagina) prolapse occurs after hysterectomy when the supports are weakened due to aging, obesity and changes in hormonal levels etc. Symptoms related to prolapse include a bulge or sensation of fullness in the vagina, or an external bulge that extends outside the vagina. It may cause a heavy or dragging sensation in the vagina or lower back and difficulties with passing urine or bowel motions. Sacrospinous Fixation Operation ref: Review: 10/2015 Page: 2

3 For some women it causes difficulty or discomfort during intercourse. What is a sacrospinous fixation? A sacrospinous fixation is an operation designed to restore support to the uterus or vaginal vault (in a woman who has had a hysterectomy). It is a vaginal procedure and uses sutures (stitches) rather than a mesh. What will happen to me before the operation? You will be asked about your general health and any medication that you are taking. Any necessary investigations (for example blood tests, ECG, chest x-ray, MRSA screen) will be organised. You will also receive information about your admission, hospital stay, operation and pre- and postoperative care. How is Sacrospinous fixation done? The procedure can be performed under regional or general anaesthetic. Your anaesthetist will discuss what will be most suitable for you. You will be lying down (with your legs in stirrups) and a pack may be inserted in the back passage (rectum) to help with the operation. An incision is made so that the vagina is freed from the underlying supporting tissue. Two stitches are placed through the strong sacrospinous ligament and secured to the top of vagina or cervix. This results in increased support to the upper vagina. The stitches can be either permanent or slowly absorbed over time - eventually they are replaced by scar tissue which then supports the vagina or uterus. This procedure is often combined with a vaginal hysterectomy and/or surgery to treat prolapse of the bladder, bowel or stress urinary incontinence. Sacrospinous Fixation Operation ref: Review: 10/2015 Page: 3

4 What are the chances of success? Quoted success rates for sacrospinous fixation are between 80 to 90%. However, there is a chance that the prolapse might come back in the future, or another part of the vagina may prolapse for which you would need further surgery. Are there any complications? With any operation there is always a risk of complications. The following general complications can happen after any type of surgery: Anaesthetic problems - With modern anaesthetics and monitoring equipment, complications due to anaesthesia are very rare. Bleeding - Serious bleeding requiring blood transfusion can occur rarely following vaginal surgery. Wound Infection - Although antibiotics are often given just before surgery and all attempts are made to keep surgery sterile, there is a small chance of developing an infection in the vagina or pelvis. Symptoms include an unpleasant smelling vaginal discharge, fever and pelvic pain or abdominal discomfort. If you become unwell contact your doctor as you may require antibiotics. Bladder infections (cystitis) this occurs in about 6% of women after surgery and is more common if a catheter has been used. Symptoms include burning or stinging when passing urine, a frequent need to urinate and sometimes Sacrospinous Fixation Operation ref: Review: 10/2015 Page: 4

5 blood in the urine. Cystitis is usually easily treated by a course of antibiotics. Damage to nearby organs (rectum, ureter, bladder, blood vessels or nerve) occurs rarely. The resulting injury may require further surgery. DVT/ Thrombosis blood clots forming in the legs or lungs Specific complications related to Sacrospinous fixation suspension include: Pain - Approximately one in ten women who have a sacrospinous fixation will get pain in their buttocks for the first few weeks after surgery. This will get better by itself, and you will be given pain killers to help. It usually settles by 6 weeks. It is also quite common to get some stabbing or burning rectal pain that settles within a short time. Constipation is a common short term problem and your doctor may prescribe laxatives for this, try to maintain a high fibre diet and drink plenty of fluids to help as well. Pain / discomfort with intercourse this can occur in 1-5% of women. Whilst every effort is made to prevent this happening, it is sometimes unavoidable. Some women feel confident and find intercourse is more comfortable after their prolapse is repaired. Failure of the operation to achieve its aim or formation of a prolapse in another part of the vagina which could require further surgery to correct the problem in the future. What are the alternative operations? Open / Laparoscopic Sacrocolpopexy Sacrocolpopexy is a procedure to correct prolapse of the vaginal vault (top of the vagina) in women who have had a previous hysterectomy. The operation is designed to restore the vagina to its normal position and function. Sacrocolpopexy is performed either through an abdominal incision or by keyhole surgery using a laparoscope under general anaesthesia. A graft made of permanent synthetic mesh is used to cover the front and the back surfaces of the vagina. The mesh is then Sacrospinous Fixation Operation ref: Review: 10/2015 Page: 5

6 attached to the sacrum (tail bone). The mesh is then covered by a layer of tissue called the peritoneum that lines the abdominal cavity; this prevents the bowel from getting stuck to the mesh. Sacrocolpopexy can be performed at the same time as surgery for incontinence or vaginal repair for bladder or bowel prolapse. We do not currently have the option of laparoscopic sacrocolpopexy in our trust. What will happen when I get admitted to the hospital for the operation? You will be welcomed by a nurse, who will explain what care you will receive and answer any of your questions. You will also be seen by your surgeon or one of their team and an anaesthetist before your operation. You will put on anti-thrombosis stockings. You will receive a daily injection of a medication which will thin your blood. This treatment is necessary to reduce your risk of clot formation which can occur as a result of your pelvic surgery. When it is time for your operation, the nurse from the ward will escort you to theatre. What will happen to me after the operation? When you wake up from the anaesthetic you will be in the recovery area of the theatre suite in your bed. A nurse and sometimes an anaesthetist will be with you. You will have an oxygen mask in place, this will help you breathe more easily and allow you to recover from the anaesthetic faster. You will have a drip in your arm to give you fluids and you will have a catheter in your bladder. Often the surgeon will place a pack inside the vagina after the operation to reduce any bleeding. Both the pack and the catheter are usually removed within 24 to 48 hours of the operation. It is sometimes difficult to urinate after the operation and the catheter will allow staff to observe that you are getting enough fluids. Once you are alert a nurse will come and take you back to the ward. The nursing staff will continue to monitor you and ensure you are comfortable. Sacrospinous Fixation Operation ref: Review: 10/2015 Page: 6

7 You will meet your consultant or member of their team who will explain how the operation went the day following surgery. It is normal to get a creamy white discharge for 4 to 6 weeks after surgery. This is due to the presence of stitches in the vagina; as the stitches absorb the discharge will gradually reduce. If the discharge has a bad smell, contact your doctor. You may get some blood stained discharge immediately after surgery or starting about a week after surgery. This blood is usually quite thin and old, brownish looking and is the result of the body breaking down blood trapped under the skin. Will I be in pain after the operation? There may be some discomfort and pain after the operation; however you will be given medications to provide relief. There are different forms of pain relief including patient controlled analgesia (PCA) which may be given to some women. It is a device which allows you to control how much pain killer (analgesia) you receive by pressing a button. When will I go home? You will be given laxatives and some food on the day of operation to facilitate a quick recovery. If all goes well and you have no complications you will be able to go home 2-3 days after the procedure. When you are discharged from the hospital you will be given pain killers (analgesics), laxatives as required and occasionally vaginal oestrogen tablets to promote healing. When can I return to my usual routine? You should be able to drive once you can do an emergency stop without any discomfort and be fit enough for light activities such as short walks within a month of surgery. You may feel more tired during your recovery period and perhaps a bit low, but as you start to recover you should notice this improves. We advise you to avoid heavy housework, lifting and sport for at least 6 weeks to allow the wounds to heal. You should try not to strain yourself during the recovery period as this may decrease the effectiveness of the operation. Sacrospinous Fixation Operation ref: Review: 10/2015 Page: 7

8 Eat high fibre foods such as fruit and vegetables and drink lots of fluids to stop you getting constipated after your operation. When can I go back to work? When you feel ready to resume work. It is usually advisable to plan to take 6-8 weeks off work. Your doctor can guide you as this will depend on your job type and the exact surgery you have had. How will the operation affect sex? You should wait six weeks before attempting sexual intercourse to allow healing to be completed. Some women initially find sex to be painful; using additional lubricant during intercourse is helpful. Lubricants can easily be bought at supermarkets or pharmacies. What follow-up will I have? You will have an outpatient appointment approx 3 months after your operation. This will allow you to tell the doctor of your progress and ask any questions. You will be examined to ensure the healing is complete and evaluate the result of your operation. You will be asked to complete a symptom questionnaire. If you have any urgent problems before this time you can contact your GP or your consultant s secretary at the hospital. Alternatives to surgery Do nothing Prolapse is rarely a life-threatening condition and many women will choose not to have any treatment if they have no symptoms or only mild discomfort. If you have been diagnosed with a mild prolapse, try and avoid heavy lifting, chronic straining (e.g. with constipation), and gaining excess weight as these can cause your prolapse to worsen. Pelvic floor exercises (PFE) - The pelvic floor muscle runs from the coccyx at the back to the pubic bone at the front and off to the sides. This muscle supports your pelvic organs (uterus and bladder) and your bowel. Any muscle in the body needs exercise to keep it strong so that it functions properly. This is more important if that muscle has been damaged. Exercising your weakened pelvic floor muscles may help improve or prevent the worsening of early stages of prolapse. Just as any exercise program, pelvic floor exercises require time, motivation and proper technique. PFE can strengthen the pelvic floor and relieve Sacrospinous Fixation Operation ref: Review: 10/2015 Page: 8

9 symptoms of mild prolapse. PFE are best taught by an expert who is usually a Physiotherapist. These exercises have little or no risk and even if surgery is required at a later date, they will help you to prevent recurrent prolapse. Pessaries These are vaginal devices that come in various shapes and sizes. Pessaries help by providing mechanical support to the prolapsed organs, thus relieving symptoms. Pessaries are most suitable if you wish to delay or avoid surgery, e.g. if your family is not yet complete or if you have medical problems that will make surgery a risk. Pessaries require fitting by your health care provider and may require some trial and error before the most suitable size and type is found for you. We can offer different types of pessaries in our trust, which need to be replaced every 4-6 months. It is possible to remain sexually active with some types of pessaries in place. References British Society of Urogynaecology 27 Sussex Place, Regent s Park, London, NW1 4RG Telephone: +44 (0) Facsimile: +44 (0) bsug@rcog.org.uk Website: I U G A (International Urogynaecology Association) Office office@iuga.org Website: Things I need to know before I have my operation. Please list below any questions you may have, having read this leaflet Sacrospinous Fixation Operation ref: Review: 10/2015 Page: 9

10 What are your expectations from the surgery? Comments, compliments or complaints We welcome any suggestions you have about the quality of our care and our services. Contact us: Freephone: Phone: Textphone: Customer Care, Reception, Macclesfield District General Hospital, Victoria Road, SK10 3BL For large print, audio, Braille version or translation contact Communications and Engagement on Admission information The trust accepts no responsibility for the loss of, or damage to, personal property of any kind, in whatever way the loss or damage may occur, unless deposited for safe custody. Please leave valuables at home. If you need to bring personal items that are expensive, for example micro hearing aids, please be aware that you do so at your own risk Sacrospinous Fixation Operation ref: Review: 10/2015 Page: 10