Laparoscopic Ventrosuspension

Laparoscopic Ventrosuspension is the management of choice for symptomatic uterine retroversion. In this condition, the womb lies backwards with its body directly behind the vaginal vault. This can cause considerable discomfort during intercourse and back pain, particularly during menstruation. Other symptoms are prolonged bleeding with cramping. The condition is also associated with impaired fertility.

A retroverted womb is, however not an abnormality and may also resolve spontaneously. Up to 40% of woman may have retroversion at examination. Management only ever becomes relevant if symptoms are significant. The Ventrosuspension operation is also only relevant where fertility is still desired. If the family is complete, a hysterectomy is a better choice for symptomatic retroversion.

The operation is conducted through 3 incisions. One at the umbilicus (belly button) to introduce the camera, and two on the bikini line, on either side of the midline. The round ligaments are used to pull the womb forward where they are attached by suture to the anterior abdominal wall. This restores the antevert or forward facing position of the womb.

The round ligaments are extremely sensitive and this operation is associated with considerable discomfort. Recovery can take up to 3 weeks. Frequency (having to visit the loo often) and difficulty in standing upright is common. Patients are advised to sleep with a pillow under the knee initially. Nerve sensitivity may persist for up to three months.

Long term satisfaction with the procedure is high with excellent resolution of most symptoms.

A subsequent pregnancy is unaffected by the procedure, however, this may lead to a recurrence of the retroversion.

Dr Douglas Seton, Obestetrician & Gynaecologist Knysna © 2021

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