Sacrocolpopexy for the Treatment of Vaginal Prolapse
By Marja Sprock, M.D.

To repeat the word sacrocolpopexy three times in a row is a tongue twister. Sacrocolpopexy is a surgery to suspend/support the vagina to a ligament on the sacrum. Like repair of a vaginal prolapse through the vagina, if a sacrocolpopexy is performed laparoscopically or robotically, it is considered “minimally invasive” pelvic reconstructive surgery. It can also be done by laparotomy, which means by abdominal incision, however the trend is to keep these surgeries, even though they require a high surgical skills set, minimally invasive for the patient’s sake.

I will explain some of the indications and considerations for sacrocolpopexy as well as enhance the understanding of the sacrum-vagina support surgery.

Prolapse of the vagina means that some of the inside vaginal walls are falling down. Behind these inside walls can be bladder, small bowel or rectum and the uterus can descend also. One wall, two walls or all of the vagina can fall down like “a sock” being turned inside out. Often the repair is performed through the vagina, with incisions in the vagina, with or without the placement of mesh. In patients with severe prolapse, failed previous vaginal repairs or younger patients, a sacrocolpopexy is often preferably performed. The failure rate of vaginal surgery is higher than laparoscopic surgery. The chance that a mesh erodes (comes through) the vaginal wall is also less, however if it does, more difficult to treat. Also in defense of the vaginally used mesh, the problem with erosions is currently minute if light weight meshes are chosen.

In sacrocolpopexy, the vagina will be surgically approached from an abdominal view, like viewing the vagina from the air and not from the ground. A mesh is attached to the top of the vagina, and extended to the front (underneath part of the bladder) and the back of the vagina, like the top portion of a Y. The lower part of the Y shaped mesh will be attached towards the right side of a ligament on the sacrum.

Most surgeons will cover a good portion of the mesh with peritoneum (tissue covering the abdominal organs); theoretically this is performed to diminish the chance of bowel adhering to the mesh.

With any abdominal surgery there is always the chance of bowel injury, obstruction or slowing it down temporarily. The chance of injury to the bladder or any other structure like a ureter is higher in the abdominal approach to prolapse repair than the vaginal one.

The sacrocolpopexy is a highly specialized procedure, requiring a specially trained surgeon. The minimally invasive approach using either the robot or the laparoscope demands a high surgical expertise. In Brevard county Dr. Sprock is the only surgeon currently performing the sacrocolpopexy in a minimally invasive fashion. Good news for women, since it is definitely a surgical option that should be available for the woman where no prolapse surgery seems to hold, the ones with a high recurrence rate or the very difficult prolapse. It used to be a first choice in young sexually active women or young women otherwise requiring two vaginally inserted meshes, however the vaginally inserted meshes have improved significantly over the last couple of years.

The robot are a tool used to make the minimally invasive, no large abdominal incision, surgery easier to perform for the surgeon. It is laparoscopy, using small instruments and a camera to enter the abdomen, but then the robot will hold the instruments and the surgeon sits at the console. A recent study showed that the robotic approach required more time under anesthesia for the patient and also caused more pain than the straight laparoscopic approach. Either robotic sacrocolpopexy or laparoscopic sacrocolpopexy are an advancement for women over the open abdominal approach. Hospital stay may be overnight, pain is usually experienced as someone having pushed you in the stomach for about 3 days and bladder and bowel recoup usually expediently.

Before you have a bothersome prolapse repaired, make sure that you have carefully evaluated all your options. Your surgeon may not offer you a sacrocolpopexy because it is not the right procedure for you or you would not be in a good enough physical condition; however make sure that it is not because your surgeon does not have the capability to do so. If you are young, healthy, and sexually active or have had several failed prolapse repairs it may be best choice.

Keep in mind: not every prolapse needs repair; there are different organs that can prolapse into the vagina, with more or less severity with more or less symptoms.

The solution to your prolapse depends on a lot of factors. If you’d like to discuss all your options and have a physician who is capable of offering them to you, see Dr. Sprock in Rockledge. As a fellowship trained urogynecologist under Dr. David Richardson at Henry Ford Hospital in Detroit, she brings years of experience and a high surgical expertise.

Call our Rockledge office at 321-806-3929, send us a note or visit us online at www.CFUroGyn.com.