Pelvic Reconstruction: Abdominal Approach

Abstract

Surgical repair of pelvic organ prolapse can be accomplished via a laparoscopic approach, abdominal approach, vaginal approach, robotically, or a combination of routes. In some instances, medical necessity requires a patient to have a laparotomy for nonreconstructive indications, and in such instances it makes sense to take advantage of the abdominal incision which provides generous access to pelvic support structures and good availability of anchoring sites to accomplish the desired reconstructive surgery. In other instances, surgeons choose an abdominal approach because data have shown excellent, long-lasting results through the abdominal approach and because the surgeon believes that the patient's severity of prolapse and/ or the life expectancy of the patient mandates the more invasive abdominal approach in order to obtain lasting results [1] . The main objectives of pelvic reconstructive surgery are the restoration of normal vaginal anatomy, relief of symptoms presumed to be caused by abnormal pelvic floor anatomy, restoration or maintenance of normal bladder and bowel function, and restoration and/or maintenance of normal sexual function. Abdominal repairs for pelvic reconstructive surgery include paravaginal repair for cystocele, methods for vaginal apex suspension (ligament suspensions of the vaginal apex, and abdominal sacral colpopexy (ASC). Pelvic cul-de-sac closure techniques also are used for prevention or treatment of enterocele. With some modifications, the ASC also can be used to repair a wide spectrum of defects including cystocele, rectocele, as well as vaginal apex prolapse. Each of the procedures performed through an abdominal approach can be accomplished via a laparoscopic approach; however, technical skills to accomplish these procedures are advanced, and in general, only surgeons with advanced laparoscopic skills and previous experience with open reconstructive surgeries can execute laparoscopic repairs with safety and efficacy.