Pelvic organ prolapse is a common condition where one or more pelvic organs, such as the uterus, bladder, or rectum, shift from their normal positions and may sag into or outside the vagina. This occurs when the muscles, ligaments, and tissues supporting these organs weaken or become damaged. While not life-threatening, pelvic organ prolapse can significantly impact a person’s quality of life by causing discomfort and various symptoms. Sacrocolpopexy is a surgical procedure considered a highly effective option for treating this condition.
What is Sacrocolpopexy?
Sacrocolpopexy involves using surgical mesh to lift and secure the prolapsed pelvic organs back into their proper anatomical positions within the pelvis. The primary purpose of this operation is to provide long-term support and restore the natural alignment of the pelvic structures.
During the procedure, a synthetic mesh, often made of monofilament polypropylene, is attached to the top of the vagina, or vaginal vault, and then secured to a strong ligament covering the sacrum, which is located at the base of the spine. This creates a durable suspension system, effectively pulling the prolapsed organs upwards and holding them in place. The mesh acts like a bridge or synthetic ligament, re-establishing the support that weakened tissues can no longer provide, offering robust and lasting support.
Conditions Treated by Sacrocolpopexy
Sacrocolpopexy is primarily performed to address specific types of pelvic organ prolapse. It is particularly effective for vaginal vault prolapse, which occurs after a hysterectomy when the top of the vagina loses support and descends. The procedure also treats uterine prolapse, where the uterus sags into the vaginal canal.
Beyond these, sacrocolpopexy can correct other forms of pelvic organ prolapse, including cystocele, which is the bulging of the bladder into the vagina, and rectocele, where the rectum protrudes into the back wall of the vagina. Enterocele, involving the small bowel bulging into the vagina, is another condition managed by this surgery. These conditions can lead to symptoms like a feeling of pressure or a bulge in the vagina, discomfort during sexual activity, and problems with urination or bowel movements.
How the Procedure is Performed
Sacrocolpopexy can be performed using several surgical approaches. The traditional open abdominal approach involves a larger incision in the lower abdomen to provide the surgeon with a direct view of the pelvic organs.
Minimally invasive techniques offer reduced recovery times and smaller incisions. The laparoscopic approach uses several small incisions through which a camera and specialized instruments are inserted. This allows the surgeon to visualize the pelvic cavity on a monitor and perform the procedure with precision. The robotic-assisted laparoscopic approach further enhances this by providing a magnified, 3D view and allowing the surgeon to control robotic arms with greater dexterity and range of motion.
The surgeon carefully separates the bladder and rectum from the vagina to create space for the mesh. Synthetic mesh, typically made of monofilament polypropylene, is then meticulously attached to the anterior and posterior walls of the vagina. This mesh is then secured to the sacral promontory, a strong ligament near the tailbone, effectively suspending the vagina and any prolapsed organs.
Recovery and Long-Term Outlook
Following sacrocolpopexy, immediate post-operative care focuses on managing discomfort. Patients typically remain in the hospital for a few days. Pain medication is provided to manage discomfort, and a urinary catheter may be temporarily in place.
During the initial healing period, certain activity restrictions are necessary. Patients are typically advised to avoid heavy lifting, strenuous exercise, and sexual activity for approximately six to eight weeks. Gradual resumption of normal activities is encouraged as healing progresses.
Sacrocolpopexy has high success rates in alleviating prolapse symptoms and improving quality of life. Long-term success rates for correcting vaginal or uterovaginal prolapse range from 85% to 90%, with a low risk of prolapse recurrence. While mesh-related issues or recurrence can occur, these are rare. The procedure is generally regarded as very successful in restoring anatomical support and function.