Sacrocolpopexy - Procedure, Risks, and Recovery

Introduction:

Sacrocolpopexy, also known as sacral colpopexy, is a surgery done to correct the pelvic organ prolapse. Pelvic organ prolapse causes the pelvic floor's muscles, tissues, and ligaments to become loose and weak, resulting in sagging of the pelvic organs (uterus, cervix, vagina, urethra, bladder, and rectum). This can occur after childbirth due to complications like stretching and torn muscles or aging.

What is Sacrocolpopexy?

Sacrocolpopexy, an effective and safe surgical procedure to treat pelvic organ prolapse. This recreates the natural supporting structure of the uterus and vagina by using a mesh that imitates the support previously provided by pelvic ligaments. It relieves symptoms like difficulty emptying the bladder or bowels, incontinence, a bulge in the vagina, and sexual dysfunction. It can be performed in three approaches: abdominal /open surgery, laparoscopic or robotic-assisted.

What is Pelvic Organ Prolapse?

Pelvic organ prolapse is a condition that weakens the support of pelvic floor muscles, resulting in drooping of the pelvic organ. This happens because of stretched, weakened, or torn; support systems causing pelvic organs to slip out of their original position or sag down (prolapse).

Depending on the organ involved, there are different types of pelvic organ prolapses :

• Vaginal Vault Prolapse - This happens when the upper part of the vagina drops into the vaginal canal. This may be due to the weakening of muscles and tissues of the vagina. The most common cause of vaginal vault prolapse is hysterectomy (the surgical removal of the uterus)

• Uterine Prolapse - The uterine wall prolapse happens when the pelvic muscles and ligaments stretch beyond the uterus's ability to support, causing the uterus to drop out of the vagina. This is commonly seen in complicated pregnancies (delivery of a large baby or trauma during birth), obesity, chronic constipation, and heavy lifting jobs.

• Bladder Prolapse - It is also known as cystocele or anterior prolapse. It occurs when the bladder and vaginal wall weaken, causing the bladder to bulge into the vagina. The conditions that cause uterine prolapse also cause bladder prolapse.

• Enterocele Prolapse - This condition happens when the small intestine drops into the pelvic cavity and pushes at the vagina, causing bulges due to complicated childbirth and old age.

• Rectocele Prolapse - This occurs when the thin wall of tissue that separates the vagina and rectum weakens, causing the vaginal wall to bulge and droop. Obesity, heavy lifting, complications from childbirth, and constipation are all common factors contributing to this condition.

How Is Scarocolpopexy Performed?

In a sacrocolpopexy procedure, a surgical mesh (a device that provides additional support to damaged and weakened tissues) is attached from the vagina to the tailbone, which is the bone at the base of the spine. If required, the uterus will be removed with or without the cervix. If the cervix is present, the mesh will be attached over the top of the cervix and to the vaginal walls.

Generally, there are three approaches to sacrocolpopexy procedures done:

Abdominal/Open - Abdominal sacrocolpopexy is optimum for complex cases and when excessive scar tissues are present, which requires hand on dissection of tissues. The surgery is done through a small 6 to 8-centimeter incision near the bikini line on the lower abdomen.

Laparoscopy - This approach uses a small keyhole incision through which a tiny camera and the surgical instrument are introduced, and the following steps are performed :

• General anesthesia is administered to the patient.

• Small keyhole incisions are made on the stomach.

• Using carbon dioxide gas the abdomen is inflated, so space is created through which the surgery can be performed.

• A laparoscope and other surgical instruments are passed through the keyhole incisions.

• A surgical mesh (a device that provides additional support to damaged and weakened tissues) is fixed to the front and back walls of the vagina and the sacrum to suspend the the cervix or the top of the vagina back into its normal position.

• In many cases, the uterus is removed depending upon age and family history. Depending on the patient's opinion, the fallopian tubes and/or ovaries are removed, in some cases.

• If the bladder and rectum are weak and need support, surgeons repair these areas through the vagina.

• If the patient complains of urinary incontinence, a small mesh is placed underneath the urinary bladder to support the patient laughing, coughing, or sneezing.

• Using a small camera, the inner side of the bladder is examined at the end of the procedure to make sure that there are no injuries caused during surgery.

Robotic-Assisted - Robotic-assisted or robotic sacrocolpopexy is similar to laparoscopic surgery. It involves a computer-assisted robotic arm operated by the surgeon that can drive in highly tight places and perform motions beyond the range of the human hand. It can be expensive and sometimes take more time to complete.

What Is the Risk After Sacrocolpopexy?

• The general risk after every surgical procedure is pain, blood loss, infection, and reaction to anesthesia.

• There are chances of prolapse occurring in other parts of the vagina.

• Constipation can occur after surgery which can be treated by drinking adequate water and dietary fibers.

• Exposure of mesh in the vagina, rectum, or bladder. It can be corrected by vaginal estrogen cream or excision of a portion of the mesh if this happens.

• Pain during intercourse.

• Damage to the bowel, uterus, or bladder.

What Are the Things to Remember During Recovery After Sacrocolpopexy?

Recovery after sacrocolpopexy is a gradual process. Good care and rest are required during the recovery period, and a few things to be considered include :

• Women are expected to stay in the hospital for 2 to 3 days after the surgery and 4 to 6 weeks of rest at home.

• Avoid heavy weight lifting and tiring housework like mopping, vacuuming, lifting heavy grocery bags, or standing for a long time for the first eight weeks after the surgery.

• Avoid doing exercise, swimming, aerobic conditioning, or spa baths for the first six weeks.

• Avoid intercourse for the first six weeks.

• It is recommended to wear compression stockings on your legs; this helps to prevent blood clot formation.

• Drink adequate water and nutritious, fiber-rich food to prevent constipation.

Conclusion:

Sacrocolpopexy is an effective surgery for pelvic organ prolapse, with a significantly lower rate of recurrence and complication. With tremendous improvements in the medical field, robotic-assisted sacrocolpopexy surgery has become more accurate, effective, and less complicated.