Sacrocolpopexy is a surgical procedure to correct vaginal or uterovaginal prolapse. It can be performed along with a hysterectomy or in women who have previously undergone a hysterectomy. In this surgery, the hernia of the vaginal walls is reinforced with a hernia mesh, providing the most durable anatomic outcomes for women with prolapse.
How is the surgery performed?
At Northwestern Medicine, your urogynecologist will perform the sacrocolpopexy via a minimally invasive surgical route, either utilizing conventional laparoscopy or the da Vinci Surgical System. You and your urogynecologist will determine which minimally invasive route is right for you. Regardless of the route you choose, both are performed through tiny incisions in the abdominal wall, sometimes referred to as “keyhole” surgery. The surgery will be performed under general anesthesia with an anesthesiologist monitoring your heart and lung function throughout the surgery.
If you are having a hysterectomy performed, your urogynecologist will perform this first. Once the “cuff” or top part of your vagina is approximated, the remainder of the surgery is the same as if you had already had a hysterectomy. Once the vaginal walls are surgically separated from the surrounding bladder and bowel tissue, the synthetic mesh is attached to the vaginal walls and anchored to a ligament on the sacrum (near your tailbone).
Often this surgery is performed at the same time as an incontinence surgery to treat urinary incontinence.
How successful is the surgery?
Sacrocolpopexy is well studied in numerous high-quality clinical trials and remains the most durable procedure for surgically managing the symptoms associated with vaginal or uterovaginal prolapse. Most studies demonstrate that 85 to 90 percent of women are satisfied with their symptom control and do not require further therapy for prolapse.
Are there complications?
As mentioned previously, this surgery has been extensively studied, and thus the complications are very well known. Your urogynecologist will evaluate you and will modify certain things that might predispose you to a complication. Specific risks unique to this surgery include mesh exposure (a portion of the mesh visible in the vagina) and mesh erosion into the bowel or bladder systems. Although rare, if you experience a complication, your doctor will address this immediately utilizing surgical or non-surgical techniques.
Complications general to any type of surgery, including blood clot, infection, bleeding, or nerve or muscle injury, can be encountered with this surgery as well. Again, your urogynecologist will work with you, your primary care team, and our anesthesiology team to minimize your risk of these things happening.
What is the recovery?
Since your urogynecologist is able to perform this surgery utilizing a minimally invasive approach, you will most likely be able to go home the day of surgery. To help you accomplish this goal, we have worked with our anesthesiology team to develop an Enhanced Recovery After Surgery (ERAS) program. Your urogynecologist will determine if you are a candidate for this program at your pre-surgical visit.
We also appreciate that you are undergoing surgery to restore your quality of life, and thus we would like to get you doing the things you want to do as quickly as possible postoperatively. We ask you to abstain from sexual intercourse for six weeks while the stitches in your vagina are healing.
You can return to your normal activities as soon as you feel ready including exercise and work.
How should I prepare for surgery?
You will meet with your surgeon as well as our nurse preoperatively to discuss specific instructions to follow before and after surgery.