Sacrocolpopexy is a procedure to correct prolapse of the vaginal vault (top of the vagina) in women who have had a previous hysterectomy. The operation is designed to restore the vagina to its normal position and function.
What is Sacrocolpopexy
Sacrocolpopexy is performed through abdominal incisions or ‘keyholes’ (using a laparoscope or a surgical robot), under general anesthesia.
The vagina is first freed from the bladder at the front and the rectum at the back. A graft made of permanent synthetic mesh is used to cover the front and the back surfaces of the vagina. The mesh is then attached to the sacrum (tail bone) as shown in the illustration. The mesh is then covered by a layer of tissue called the peritoneum that lines the abdominal cavity; this prevents the bowel from getting stuck to the mesh. Sacrocolpopexy can be performed at the same time of surgery for vaginal repair for bladder or Rectum prolapse.
Exercise – exercises focusing on pelvic floor muscles can help to improve mild cases of prolapse (Kegel exercises)
Vaginal Pessary – A pessary is a rubber or plastic device used to support the pelvic floor and maintain support of the prolapsed organ. A health care provider will fit and insert the pessary, which must be cleaned frequently and removed before sexual intercourse.
Estrogen Replacement Therapy (ERT) – Estrogen may help to limit further weakness of the muscles and other connective tissues that support the uterus. However, there are some drawbacks to taking estrogen, such as an increased risk of blood clots, gallbladder disease and breast cancer.
Surgical options are used to help return prolapsed organs to a normal anatomical position and to strengthen structures around the prolapsed area.
Surgical options can be performed abdominally or vaginally:
Involves making an incision in the vagina, followed by a dissection, separating the prolapsed organ from the vaginal wall and using stitches and/or mesh to strengthen and repair the vagina.
This involves making an incision in the abdomen and using sutures and/or mesh materials to support the vagina, vaginal vault or uterus.
Laparoscopic and robotic approaches
They offer treatment to similar procedures as the open abdominal approach but often with quicker recovery time and smaller scars. In Sacrocolpopexy, done utilizing the laparoscopic approach, a prolapsed vaginal vault is supported by using mesh attached to the sacrum.
Is mesh always necessary?
Not all treatments require mesh.
Traditionally, grafts are used in repeated surgeries and where significant, risk factors for failure exist. You should discuss the pros and cons of the use in detail with your surgeon.
The FDA has established an on-line list of voluntary reports on medical devices which may have malfunctioned or caused death or serious injury. This information is located on the Manufacturer and User Facility Device Experience Database (MAUDE). The FDA issued a safety communication regarding complications related to pelvic organ repair using mesh: http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm262435.htm
Ask your doctor about prolapse repair and if the EndoFast SCP procedure can fit your clinical needs.
Care after Surgery
You can expect to stay in the hospital between 2-5 days. During the first 6 weeks you should avoid any type of heavy housework or lifting, including shopping bags, laundry baskets, vacuuming, etc. Gentle walking is good exercise. Start with about 10 minutes a day when you feel ready build up gradually; avoid any fitness type training, aerobics etc. for at least 6 weeks after surgery. Swimming, spa baths and intercourse should also be avoided for 6 weeks following surgery.
Generally you will need 4 to 6 weeks off from work, this period may be longer if you have a very physical job.