June 22, 2022 Author : Manuela Costa Sacrocolpopexy is a surgery in which is corrected a prolapse of the vaginal vault (top of the vagina) that can occur in women who have previously had a hysterectomy (removal of the uterus). Sacrocolpopexy aims to place the vagina in its normal position and preserve its function. How is a sacrocolpopexy performed? There are two approaches to perform this surgery: Laparoscopy (minimally invasive surgery), in which the access of surgical instruments and a camera to the abdominal cavity is made through small incisions or holes and the surgery is guided by the high-definition images transmitted to a monitor in the operating room; By laparotomy or open surgery , through a large incision and with the abdomen open. In either case, sacrocolpopexy is performed under general anesthesia . First, are detached (or separated) the anterior vaginal wall from the bladder and the posterior vaginal wall from the rectum. Then, one end of a prosthesis (mesh) is attached to the anterior and posterior walls of the vagina and the other end to a ligament adjacent to the sacrum (the terminal bone of the spine). Then the entire length of the prosthesis is covered with peritoneum (membrane that covers the abdominal organs), to prevent adhesions of the intestines to the prosthesis. According to several studies, the success rate of sacrocolpopexy is 80%-90% . After this surgery there is a reduced risk of prolapse of another area of the vagina - the anterior wall, which supports the bladder - which, however, can be corrected with another surgery. Risks and complications of sacrocolpopexy All surgical interventions have potential risks or complications , both associated with the surgery itself and with anesthesia. As for surgery, there are general risks and complications and procedure-specific risks and complications. The most frequent risks and complications of sacrocolpopexy , whether performed by laparoscopy or laparotomy, are: Pain, including during sexual intercourse, in about 2%-5% of cases; Erosion of the prosthesis, in 2%-4% of cases. There is a small risk that this erosion will occur to adjacent organs such as the bowel, bladder, or vagina. It is not common, but surgery may be necessary to remove this part of the prosthesis; Bladder or ureter injury in 1%-2% of cases; Intestinal motility disorders, such as constipation or even intestinal obstruction in 2%-3% of the cases; Bladder function disorders such as difficulty emptying the bladder (10%), or a very weak stream of urine right after surgery, which usually recovers spontaneously in the weeks following surgery. General risks and complications include infection of surgical wounds, urinary tract infection, bleeding with possible need for a blood transfusion, deep vein thrombosis, respiratory infections, or heart problems. In each case, the surgeon and anesthesiologist also assess potential specific risks associated with the particularities of each person. Preparation for surgery In order to undergo surgery, it may be necessary to suspend some usual medication, an issue that is previously evaluated with the surgeon and/or the assistant physician who has prescribed it. Some surgeons recommend that a bowel cleansing preparation be done prior to surgery. It is also necessary to fast for 6 hours before surgery. All necessary indications are given prior to surgery . Recovery after a sacrocolpopexy For about 6 weeks after performing a sacrocolpopexy, the following should be avoided: Efforts during professional or domestic activity, for example carrying weights, vacuuming or exercising, among others; Immersion baths and use of swimming pools; Sexual relations. You can take walks that do not cause any discomfort. Any other restrictions or instructions given by the surgeon at the time of discharge must be followed. Sources I nternational Urogynecologial Association. Sacrocolpopexy . Meet the obstetrics-gynecology clinical team from Hospital da Luz network. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
