Abdominal Sacrocolpopexy

Sacrocolpopexy (also called sacral colpopexy) treats prolapse of the top of the vagina, most often after a hysterectomy, when the vault has dropped toward or out of the vaginal opening. Strips of synthetic mesh are sewn to the front and back walls of the vagina and the other end is fixed to the strong ligament on the front of the sacrum, so the vagina is held up in its natural direction. It is considered the gold standard for this kind of prolapse, with lower recurrence than repairs done through the vagina, at the cost of a longer operation and recovery. The operation can be done open (abdominal), laparoscopically or robotically with the same steps; this page covers the open abdominal approach. What makes it different from other pelvic surgery is that it works at two levels: an assistant pushes the vagina up from below with an EEA sizer or sponge stick while the surgeon sews mesh deep in the pelvis, and then the surgeon works directly on the front of the sacrum, next to the aortic bifurcation, the right ureter and the large veins of the pelvis. It is often combined with a hysterectomy, a cul-de-sac closure, a paravaginal or incontinence repair, and a vaginal repair at the end. The most feared problem during surgery is bleeding from the veins in front of the sacrum, which can be life-threatening. Bowel, bladder and ureter injuries and infection can occur, as in any abdominal surgery. The most common late problem is mesh wearing through the vaginal wall (erosion).