The classic, laparoscopic (endoscopic) treatment of the problem of prolapse of the uterus and vagina (hieropexy) has been known for a long time. At the same time, the problems that can arise from such an operation are known, and which mainly have to do with the appearance of chronic pain during defecation after the surgery.

The solution is provided by a modern laparoscopic technique, which is applied in urogynecological centers abroad and which has been proven to eliminate the possibility of chronic post-operative pain, while at the same time minimizing the possibility of complications during the operation.

Laparoscopic pectopexy is now also applied in our country, providing a solution to a problem that concerns many women.

THE specialized gynecologist – endoscopic surgeon Ioannis Raptis answers the most important questions:

What is uterine prolapse and what symptoms does it cause?

Uterine (and vaginal) prolapse is called the retreat (descendence) of the uterine organ into the vagina due to the relaxation of the supporting tissues, which hold it in place.

The condition causes intense discomfort, such as the feeling of a foreign body in the vagina, abdominal pain and urination disorders.

One of the main effects of uterine prolapse is the disruption of the sexual life of the patients, as well as the mental burden this entails.

How common is the condition?

The problem is very common, since it is estimated that 35-50% of women after menopause will at some point experience uterine or vaginal prolapse.

This percentage is much higher than most people think, since many patients hesitate to report their problem to their gynecologist, either because sex life after menopause is still considered a taboo subject, or because they do not know that there is a permanent, safe and effective surgical solution to their problem.

What causes uterine and vaginal prolapse?

Prolapse is due to the loosening of the ligaments and muscles that support the uterus and vagina.

This relaxation is most often related to a history of multiple or traumatic normal births, while factors related to a chronic increase in pressure inside the abdomen, such as obesity, standing, heavy occupations, chronic cough, etc., also play an important role.

What are the disadvantages of the classic technique used to treat the problem in our country?

Nowadays, laparoscopic lifting of the uterus and vagina using a non-absorbable mesh, which is fixed at the base of the spine, at the back of the pelvis (hieropexy), is common.

However, this area is rich in vascularity and innervation, with the result that there is a risk of injury to the vessels and nerves of the area during the surgery.

At the same time, the mesh is placed in an area near the end of the intestine, with the result that a significant percentage of women complain of chronic pain during defecation after the surgery.

Finally, the operation shows a high degree of difficulty in overweight or obese patients.

Advantages of laparoscopic pectopexy compared to the classic technique.

The main difference of the laparoscopic ctenopexy from the classic method, consists in fixing the mesh in an area on the side walls of the pelvis (ctenoid ligaments), away from vessels, nerves and the final part of the intestine.

This has the effect of eliminating the risk of injury to vessels and nerves in the area of ​​fixation of the mesh, while there is no possibility of discomfort during defecation after the operation. At the same time, the technique can be safely applied to overweight or obese women.

Are there any studies that confirm the advantages of this new method?

In 2015, the first prospective study* comparing the effectiveness and possible postoperative complications of the modern (ctenopexy) and the classic (hieropexy) method was published, which confirmed the universal superiority of the new operation.

This research is the first research worldwide, which compares with such a reliable methodology the effectiveness of two operations concerning uterine and vaginal prolapse.

* Journal of Endourology: Laparoscopic Pectopexy – A Prospective, Randomized, Comparative Clinical Trial of Standard Laparoscopic Sacral Colpocervicopexy with the New Laparoscopic Pectopexy—Postoperative Results and Intermediate-Term Follow-Up in a Pilot Study

Is laparoscopic pectopexy safely performed in Greece?

After many years of implementation of the operation in a urogynecological center (AGUB II) in Germany, we continued with great pleasure the implementation of this modern method from November 2017 in Greece as well with absolute success. The above experience combined with the import of the necessary material equipment from Germany are a guarantee for the safe implementation of the operation in our country as well.