Sacrocolpopexy

Sacrocolpopexy is a surgical procedure designed to correct pelvic organ prolapse (POP), specifically when the top of the vagina (vaginal vault) sags after a hysterectomy. It involves using a synthetic mesh to lift and support the vagina, attaching it to the sacrum (tailbone) to restore its natural position and relieve uncomfortable symptoms.

What is Sacrocolpopexy?

Sacrocolpopexy is a surgical procedure that repairs pelvic organ prolapse (POP), a condition where pelvic organs drop from their normal position. This surgery specifically addresses vaginal vault prolapse, which occurs when the top of the vagina sags after a hysterectomy (surgical removal of the uterus). The procedure uses a synthetic mesh to lift and secure the vagina to the sacrum (tailbone).

This surgery aims to restore the vagina to its correct anatomical position within the pelvis. It provides strong, long-lasting support to the vaginal vault, preventing it from prolapsing again. The procedure involves attaching a Y-shaped piece of synthetic mesh to the front and back walls of the vagina. The other end of the mesh is then securely attached to the sacrum, which is a triangular bone at the base of your spine. This creates a durable hammock-like support structure. Sacrocolpopexy is considered a highly effective method for treating significant vaginal vault prolapse. It helps to alleviate symptoms such as a feeling of pressure, a bulge in the vagina, or difficulties with bladder or bowel function.

Why it's done

Sacrocolpopexy is performed to treat pelvic organ prolapse (POP), particularly vaginal vault prolapse, which often occurs after a hysterectomy. The goal is to relieve uncomfortable symptoms caused by the sagging of pelvic organs, such as a feeling of pressure, a bulge in the vagina, or problems with bladder or bowel control, thereby improving quality of life.

When pelvic organs, such as the bladder, rectum, or uterus, drop into the vagina, it can cause a range of bothersome symptoms. These symptoms might include a feeling of heaviness or pressure in the pelvis, seeing or feeling a bulge coming out of the vagina, or experiencing pain during sexual intercourse. Some people also experience urinary problems, such as leakage (incontinence) or difficulty emptying the bladder completely. Bowel issues, like constipation or difficulty with bowel movements, can also occur. Sacrocolpopexy is often recommended when these symptoms significantly impact daily life and other, less invasive treatments have not been successful. While it can treat various types of pelvic organ prolapse, it is most commonly performed for vaginal vault prolapse, which is the sagging of the top of the vagina after the uterus has been removed. It can also be used to correct other types of prolapse, such as a dropped bladder (cystocele) or rectum (rectocele), when they occur alongside vaginal vault prolapse.

How to prepare

Preparing for sacrocolpopexy involves several steps to ensure you are healthy enough for surgery and to minimize risks. Your doctor will conduct a thorough physical exam, review your medical history, and may order tests like blood work or an electrocardiogram. You will also receive specific instructions regarding medications, diet, and bowel preparation before the procedure.

Before your surgery, your healthcare team will provide detailed instructions. It is crucial to follow these instructions carefully. You may need to stop taking certain medications, such as blood thinners, for a period before surgery to reduce the risk of bleeding. Always discuss all your medications, including over-the-counter drugs, supplements, and herbal remedies, with your doctor. You will likely be asked to fast for a certain number of hours before the surgery, meaning no food or drink. Your doctor might also recommend a bowel preparation, which involves using laxatives or enemas, to clear your bowels before the procedure. This helps to reduce the risk of infection and improves visibility for the surgeon. It is also important to arrange for someone to drive you home after your hospital stay and to help you during the initial recovery period. Your doctor will discuss the specific type of anesthesia that will be used, usually general anesthesia, which means you will be asleep during the surgery.

What happens during

During sacrocolpopexy, you will receive general anesthesia to ensure you are asleep and comfortable. The surgeon will make incisions to access the pelvic area, either through an open abdominal incision or using smaller incisions for laparoscopic or robotic-assisted surgery. A synthetic mesh is then carefully positioned to lift and secure the vagina to the sacrum, restoring support.

The procedure typically takes a few hours. Once you are under general anesthesia, your surgeon will begin the operation. There are three main approaches for sacrocolpopexy: * **Open abdominal sacrocolpopexy:** This involves a single, larger incision in your lower abdomen. This approach allows the surgeon a direct view of the pelvic organs. * **Laparoscopic sacrocolpopexy:** This minimally invasive approach uses several small incisions in the abdomen. A thin tube with a camera (laparoscope) and surgical instruments are inserted through these incisions. The surgeon views the procedure on a video monitor. * **Robotic-assisted laparoscopic sacrocolpopexy:** Similar to laparoscopic surgery, this method uses a robotic system controlled by the surgeon. The robotic arms provide enhanced precision and dexterity through small incisions. Regardless of the approach, the core steps involve attaching a Y-shaped synthetic mesh to the front and back walls of the vagina. The other end of the mesh is then carefully secured to the sacrum, a bone at the base of your spine. This creates a strong, lasting support for the vagina. After the mesh is in place and secured, the incisions are closed with sutures or staples.

Recovery & timeline

Recovery from sacrocolpopexy typically involves a hospital stay of one to four days, followed by several weeks of restricted activity at home. You will experience some pain and discomfort, managed with medication. Most people can gradually return to light activities within a few weeks, but strenuous activities, heavy lifting, and sexual intercourse are usually restricted for six to eight weeks.

After surgery, you will be monitored closely in the recovery room. You may have a catheter to drain urine for a short period. Pain medication will be provided to manage discomfort. Your healthcare team will encourage you to get up and walk soon after surgery to help prevent complications like blood clots. Once you return home, it's important to rest and avoid activities that put strain on your pelvic area. You should avoid heavy lifting, strenuous exercise, douching, using tampons, and sexual intercourse for at least six to eight weeks, or as advised by your doctor. Following these restrictions is crucial for proper healing and to ensure the mesh integrates correctly. Most people can return to light daily activities, such as walking and light housework, within two to four weeks. However, a full recovery, where you can resume all normal activities, may take several weeks to a few months. Your doctor will schedule follow-up appointments to monitor your healing and progress. It's important to report any unusual symptoms, such as fever, increased pain, or discharge, to your healthcare provider.

Risks & side effects

Like all surgeries, sacrocolpopexy carries potential risks and side effects, though serious complications are uncommon. General surgical risks include bleeding, infection, and adverse reactions to anesthesia. Specific risks related to sacrocolpopexy can include mesh erosion, pain, nerve damage, injury to nearby organs like the bladder or bowel, and the possibility of prolapse recurrence.

While sacrocolpopexy is generally safe, it's important to be aware of the potential complications. General surgical risks are present with any operation. These include excessive bleeding, which may require a blood transfusion, and infection at the surgical site or within the pelvis. There is also a small risk of adverse reactions to the anesthesia used during the procedure. Specific risks associated with the use of synthetic mesh include mesh erosion, where the mesh material can wear through the vaginal tissue, potentially causing pain, bleeding, or discharge. This complication is uncommon but can sometimes require additional surgery to remove or trim the exposed mesh. Some people may experience new or worsening pain, including nerve pain, after the surgery. Other potential complications include injury to nearby organs such as the bladder, ureters (tubes that carry urine from the kidneys to the bladder), or bowel during the procedure. While the surgery has a high success rate, there is a small chance that the prolapse could recur over time, or a new type of prolapse might develop. Your doctor will discuss these risks with you in detail before the surgery.

Success rate

Sacrocolpopexy has a high success rate for long-term correction of vaginal vault prolapse and significant improvement of related symptoms. Many people experience lasting relief from feelings of pressure, bulging, and issues with bladder or bowel function. While effective, it's important to discuss individual outcomes and potential for recurrence with your surgeon.

Studies and clinical experience show that sacrocolpopexy is a very effective procedure for treating vaginal vault prolapse. It is considered one of the most durable surgical options for this condition. The goal of the surgery is not only anatomical correction but also the relief of bothersome symptoms that affect a person's quality of life. Most people who undergo sacrocolpopexy report significant improvement in their symptoms, such as the feeling of a vaginal bulge or pressure, and often experience better bladder and bowel function. The use of a strong, synthetic mesh provides robust support that helps maintain the vagina in its correct position over many years. While the success rate for anatomical correction is high, it's important to understand that no surgery guarantees a 100% permanent fix. A small number of people may experience a recurrence of prolapse or develop a new type of prolapse over time. Your surgeon will discuss the expected outcomes based on your specific situation and overall health.

Frequently asked questions

How long does sacrocolpopexy surgery take?

Sacrocolpopexy surgery typically takes a few hours to complete. The exact duration can vary depending on the surgical approach used (open, laparoscopic, or robotic-assisted) and the complexity of your individual case.

Will I have a visible scar after sacrocolpopexy?

The visibility of scars depends on the surgical approach. An open abdominal sacrocolpopexy will result in a single, larger incision scar in the lower abdomen. Laparoscopic and robotic-assisted approaches use several smaller incisions, leading to less noticeable scars.

When can I resume sexual activity after sacrocolpopexy?

You should typically avoid sexual intercourse for at least six to eight weeks after sacrocolpopexy, or as specifically advised by your surgeon. This allows adequate time for the tissues to heal and the mesh to integrate properly, minimizing complications.

Is the mesh used in sacrocolpopexy safe?

The synthetic mesh used in sacrocolpopexy is generally considered safe and effective for pelvic organ prolapse repair. It is designed to provide strong, long-lasting support. Your doctor will discuss the benefits and potential risks, such as mesh erosion, with you before surgery.

Will sacrocolpopexy affect my ability to get pregnant?

Sacrocolpopexy is typically performed after a hysterectomy, meaning the uterus has already been removed, so pregnancy is not possible. If you still have your uterus and are considering future pregnancies, discuss this with your doctor, as the procedure may not be suitable or may require modification.

What activities should I avoid after sacrocolpopexy?

After sacrocolpopexy, you should avoid heavy lifting, strenuous exercise, douching, and using tampons for at least six to eight weeks. Gradually reintroduce activities as advised by your doctor, listening to your body to prevent strain on the surgical site.

Sources

• MedlinePlus — Sacrocolpopexy
• Mayo Clinic — Sacrocolpopexy
• Cochrane Library — Sacrocolpopexy