Sacrocolpopexy

Sacrocolpopexy (sacral colpopexy) at a glance

  • Sacrocolpopexy, also known as sacral colpopexy, is a type of reconstructive pelvic surgery that corrects pelvic organ prolapse involving the top of the vagina (vaginal vault) or the cervix (lower part of the uterus) that have dropped out of the normal position and protrude downward into the vagina.
  • Symptoms of vaginal vault prolapse include vaginal bulge or protrusion from the vaginal canal, urinary incontinence, difficulty urinating or having a bowel movement and sexual dysfunction.
  • We perform open abdominal surgeries and minimally invasive (laparoscopic or robotic) sacrocolpopexy.
  • According to a study reported by the National Institutes of Health, minimally invasive sacrocolpopexy is a safe and effective surgical method of treating pelvic organ prolapse, with low rates of complications and infrequent need for reoperation.
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What is sacrocolpopexy?

Sacrocolpopexy, or abdominal sacrocolpopexy, is the surgical, reconstructive repair of pelvic organ prolapse (POP) involving the top of the vagina (vaginal vault) or the cervix (part of the uterus). According to a report in the Journal of the American Medical Association, abdominal sacrocolpopexy is considered the gold standard of treatment for advanced POP. Studies show sacrocolpopexy cures prolapse and its symptoms in 80-90 percent of women who have the surgery.

Sacrocolpopexy is often used to help women who have had a hysterectomy, as this can sometimes reduce the normal support for the upper part of the vagina. The procedure is also an excellent treatment solution for women whose vaginal vault prolapse has not responded favorably to nonsurgical treatments, such as Kegel exercises, pelvic floor exercises, weight loss or a pessary. This surgical solution is not recommended for women who wish to have children in the future.

The technique recreates the natural supporting structure of the uterus or apical vagina by using an implant that mimics the support that was previously provided by pelvic ligaments. The surgery restores the vagina’s natural position and functions. It also relieves symptoms including difficulty emptying the bladder or bowels, a bulge in the vagina, incontinence and sexual dysfunction.

Sacrocolpopexy is performed when a patient has had failed previous surgeries or is at high risk for recurrent pelvic organ prolapse based on her medical conditions, work requirements and lifestyle choices.

How we perform sacrocolpopexy

There are three approaches of sacrocolpopexy procedures performed at CU Urogynecology.

  • Open/abdominal. An abdominal sacrocolpopexy is best for complex cases, which the CU Urogynecology surgeons frequently see. The open surgery will be completed through a small 6-8 centimeter incision on the lower abdomen, near the bikini line. This option is beneficial when excessive scar tissue is expected and may require hands on dissection of tissues.
  • Laparoscopic. This form of minimally invasive surgery uses a smaller “keyhole” incision that a tiny camera and the surgical instruments are inserted through.
  • Robotic assisted. Similar to the laparoscopic surgery, the robotic-assisted, or robotic sacrocolpopexy, involves a computer-assisted robotic arm guided by the surgeon that can maneuver in extremely tight places and perform motions beyond the range of the human hand. It can also cost a little more and sometimes take more time to complete.

These two minimally invasive options often lead to less incision pain and scarring. Our physicians will look at each individual patient’s circumstances and decide if an open abdominal or minimally invasive sacrocolpopexy would be the best treatment option.

We offer a preoperative counseling session where patients and family members attend a class to learn about the procedure being performed. They can also get preoperative instructions on how to prepare for surgery and learn what to expect after surgery including the care they will need.

Based on their medical conditions, some patients may require seeing the anesthesia team prior to surgery.

During surgery, the patient will receive general anesthesia, putting her to sleep. During the procedure the surgeon separates the vagina from the bladder and from the rectum. Either the synthetic mesh or a graft is placed at the top part of the vagina or cervix.

The surgeon then secures the implant to a ligament by the tailbone where the natural ligaments of the uterus formally inserts to. The implant is then covered with the peritoneum, the layer of tissue that lines the abdominal cavity. This keeps the bowel from sticking to the mesh or graft.

Risks from sacrocolpopexy and recovery

As with all surgeries, general risks include pain, loss of blood, reaction to anesthesia and infection. With sacrocolpopexy there is a small risk of prolapse occurring in another part of the vagina, which typically happens on the back wall by the rectum. This surgery can also cause chronic constipation that can be treated with dietary fiber and adequate water intake.

Complications are not normal. The most commonly reported complications for both open and laparoscopic techniques include:

  • pain (generally or during intercourse) in 2-3 percent.
  • exposure of the mesh in the vagina in 2-3 percent.
  • damage to bladder, bowel or ureters in 1-2 percent.

Complications specifically related to mesh may include mesh exposure in the vagina, bladder or rectum. If this occurs, it typically erodes into the vagina, which can be corrected using vaginal estrogen cream or vaginal excision of a portion of the mesh.

Other complications may include pain (most often with intercourse) and damage to the bladder, ureters or bowels.

Recovery from the surgery is a gradual process, given the area of surgery and the need to prevent undue stress on the reconstructed tissues and organs. Women can expect to stay in the hospital for 2-3 days following surgery. Depending on her job, a woman may need to stay home for 4-6 weeks. If she has a physically demanding job, time off from work will need to be longer.

During the first eight weeks after surgery, women should avoid anything considered heavy housework and all lifting, such as vacuuming, mopping, lifting grocery bags or standing for long periods. We recommend beginning with easy walking as a form of exercise and gradually increasing the time and pace.

Patients should not take part in any kind of training exercises, aerobic conditioning, swimming or spa baths for the first six weeks. They should also avoid having intercourse for this period of time.