Sacrocolpopexy

A sacrocolpopexy is a surgical procedure to treat pelvic organ prolapse when your uterus or the top of your vagina drops down.

During a sacrocolpopexy, your surgeon attaches a type of mesh to your vagina and sacrum, which is in the inner side of your tailbone. The sacrum is high up in your pelvis. So, this connection keeps your vagina lifted and prevents it from coming out of your vaginal opening.

A sacrocolpopexy can treat two types of pelvic organ prolapse:

• Uterine prolapse: Your uterus and cervix drop down and outside your vaginal opening.
• Vaginal prolapse: After a hysterectomy, sometimes the top of your vagina drops down and outside your vaginal opening.

Most surgeons do the procedure using small cuts (incisions) in your abdomen to insert a camera. Some surgeons do it with the help of a robot.

If you have uterine prolapse, your surgeon may remove your uterus (hysterectomy), fallopian tubes and ovaries during a sacrocolpopexy. You’ll have an in-depth conversation with your care team to see if this is right for you.

Benefits and risks

Restoring your uterus or vagina to a normal position helps relieve symptoms of prolapse, like vaginal bulging and pressure. A sacrocolpopexy is one of the surgical options if other treatments, like a pessary, haven’t helped.

As with all surgical procedures, there are risks to a sacrocolpopexy, like:

• Damage to your bowel, bladder, blood vessels and nerves
• Excessive bleeding
• Blood clots
• Infection
• Difficulty pooping or peeing regularly
• Increased urinary leakage or new urinary leakage
• Issues with the surgical mesh, like exposure (the mesh wears through your vaginal tissue) or infection of the mesh
• Pain during sex or pain in your pelvis
• Not finding relief from your prolapse symptoms

These risks are generally rare. And the success rate of the procedure is high. Your care team will explain the benefits and risks and what to expect. Don’t hesitate to ask questions.

What happens during a sacrocolpopexy?

Your healthcare provider will tell you how to prepare for the surgery. They’ll give you instructions on when to fast, stop certain medications and more.

Most surgeons do sacrocolpopexies through small cuts (laparoscopically). Before the surgery, you’ll get general anesthesia so you don’t feel any pain. Your surgeon will:

1. Make four to five small cuts in your abdomen.
2. Inflate your abdomen with air to create space to do the surgery.
3. Insert a thin tube with a camera and other instruments through the incisions.
4. Attach a piece of surgical mesh to the walls of your vagina and then to your sacrum.
5. Make repairs to support your bladder or rectum, if necessary.
6. Look inside your bladder with a small camera to ensure it wasn’t damaged during surgery.
7. Remove all the instruments from your abdomen and close your incisions.

The surgery takes two to four hours to complete.

For robotic-assisted sacrocolpopexy, your surgeon follows similar steps. But they pass robotic controllers through small incisions in your abdomen. Your surgeon guides these small instruments during the procedure.

Sacrocolpopexy recovery

After surgery, you’ll go to a recovery area to wake up from the anesthesia. A sacrocolpopexy is often an outpatient procedure, which means you can go home the same day. But in some cases, you may need to stay overnight.

During recovery, your healthcare team will make sure you can pee on your own without the help of a catheter (small tube). They’ll also teach you how to care for your incisions.

Recovery from surgery takes about six to eight weeks for most people. Your care team will give you instructions that detail things like modifying your activities, taking care of yourself or taking medications.

What to expect after surgery

After surgery, you may have:

• Pain, so follow your provider’s instructions for taking pain medicine
• Sleepiness and confusion, which are side effects of anesthesia
• Constipation, which stool softeners and laxatives can help with
• Gas pains and abdominal swelling for 24 to 72 hours
• A catheter to help you pee, if needed
• Light bleeding (spotting) and whitish yellow vaginal discharge for up to six weeks

Suggestions for recovery

To help aid your recovery, follow these steps:

• Get plenty of rest after the procedure. A responsible adult should stay with you for the first one or two nights after surgery.
• Drink plenty of fluids and eat bland, low-fat foods, like crackers and chicken broth. Avoid fatty foods, which can cause nausea. Expand your eating plan gradually.
• Walk around your house to exercise your calf muscles and prevent blood clots from developing.
• Go up and down stairs slowly, especially the first few days after surgery.

Things to avoid after surgery

After surgery, your healthcare provider will likely have you avoid:

• Showering for 48 hours
• Swimming or soaking in water for four to six weeks
• Lifting, pushing or pulling for four to six weeks
• Sexual intercourse or placing anything in your vagina (like tampons) for six to eight weeks
• Driving or operating heavy machinery if you’re taking prescription pain medication

When should I call my healthcare provider?

Your provider will schedule a follow-up appointment within two weeks of surgery. They’ll want to make sure it was successful and that you’re healing well.

Call your provider if you:

• Can’t pee for several hours or can only pee small amounts at a time
• Get a fever of 100.4 degrees Fahrenheit (38 degrees Celsius) or chills
• Have incisions that are discolored, swollen or leaking pus
• Have nausea or vomiting
• Have vaginal bleeding and soak more than one pad an hour
• Have foul-smelling vaginal discharge
• Have severe pain that doesn’t get better with pain medication.
• Have pain and swelling in your legs
• Have foul-smelling or cloudy pee or it hurts to pee

What is the success rate of sacrocolpopexy?

The success rate for this procedure is high. Factors such as the severity of the prolapse and the surgical method may affect the success of a sacrocolpopexy.

Prolapse can come back. To help prevent this, take steps like:

• Avoid straining to poop.
• Get treatment for a cough to prevent chronic coughing.
• Maintain a healthy weight.

Call your provider if you begin to feel symptoms of pelvic organ prolapse after surgery. In some cases, surgery isn’t successful. Your provider may need to treat the condition in another way.