What is sacro-colpopexy?
Sacro-colpopexy is a surgical procedure in which mesh is used to suspend the uterus / the vaginal vault to the sacrum. The procedure is performed through an abdominal incision or via keyhole (minimally invasive surgery_ - this is called Laparoscopic sacro-colpopexy.
How does sacro-colpopexy work?
The vaginal vault prolapses as a result of damage to the connective tissue system which suspends the vagina to the pelvic floor muscles and bony landmarks. Using soft mesh materials sutured to the vaginal wall and attached to the sacrum, the vagina is re-positioned back over the top of the pelvic floor muscles and prevented from sliding out by the newly formed meshwork.
What are the surgical alternatives to laparoscopic sacro-colpopexy?
There are many different types of operations for treatment of pelvic organ prolapse. The choice of surgery generally depends on:
- the severity of the prolapse (generally graded from I to IV)
- the patient's general health
- past surgeries, in particular past repair surgeries
- the training and experience of the surgeon
- evidence from the literature -outcomes, success, failure, complications
In general, surgeons select surgical procedures for repair of pelvic organ prolapse based on:
- Route of surgery: vaginal, laparoscopic, abdominal
- Materials used in repair: patient's native tissue (traditional colporrhaphies), bio-degradable grafts (porcine, bovine, cadaver), synthetic mesh (prolene, nylon)
- Sites of suture / graft / mesh attachment: sacrospinous ligament, arcus tendineus, sacrum
This means there are many different alternatives to choose from. You need to consult and obtain a thorough understanding from your surgeon as to how, what and why you are recommended to undergo any particular type of operation, and the choice of materials to be used in the repair.
How does laparoscopic sacro-colpopexy compare with other surgical alternatives?
Evidence from clinical research indicates that sacro-colpopexy is at present the most successful operations for long-term cure of vault prolapse. At CARE, we have seen success ldefined as long-term cure consistently > 98%.
Nevertheless, it is important to recognise that prolapse occurs as a result of degradation of pelvic floor support tissues. Therefore, there is no procedure that can offer guaranteed success 100% of the time.
What types of pelvic organ prolapse are laparoscopic sacro-colpopexy suitable for?
Laparoscopic sacro-colpopexy is suitable for correction of uterine and post-hysterectomy vault prolapse. Cystocoele (prolapsed bladder) and rectocoele (prolapsed rectum) may also be reduced as these organs are attached to the vault support.
What are the benefits of laparoscopic sacro-colpopexy?
The benefits of laparoscopic sacro-colpopexy include those seen in laparoscopic pelvic floor repair - high success rates (over 90%), good anatomical restoration, little post-operative pain, reduced risk of painful vaginal scars and avoidance of vaginal strictures.
What are the risks of laparoscopic sacro-colpopexy?
Risks associated with laparoscopic sacro-colpopexy are generally uncommon. These can broadly be divided into:
- Risks associated anaesthesia
- Risks associated with the route of surgery - where laparoscopic route is chosen, the risks include blood vessel damage (abdominal wall, internal pelvic vessels), port site hernia
- Risks to structures / organs adjacent to the pelvic organ prolapse: bladder, bowel, blood vessels and nerves of the pelvis, fistula
- Risks associated with the material (s) used for repair: painful scar tissues, strictures / stenosis, graft or mesh complications (extrusion, inflammation, infection) with possible consequence of recurrent vaginal discharge, painful intercourse that may necessitate the use of antibiotics, mesh trimming and rarely removal. The incidence of mesh complications is estimated to occur in 3 to 10% of cases in which synthetic mesh is used.
Research evidence from CARE, reported in the literature, suggests that sex and age (premenopause) are risk factors for synthetic mesh exposure / erosion.
Is laparoscopic sacro-colpopexy right for me?
As every individual patient has different types of pelvic floor defects, different tissue quality, different health status, and different expectations, you should consult with your specialist to determine if laparoscopic sacro-colpopexy is right for you.
What is CARE experience in prolapse surgery?
Professor Lam and his team specialize in the management of pelvic organ prolapse. Over the last 20 years, he has treated thousands of women, many of whom have been referred by their family physicians or gynaecologists due to the complexity of their problems or previous unsuccessful surgical repairs. Professor Lam has lectured, taught and demonstrated laparoscopic and vaginal surgeries for pelvic organ prolapse at many national and international meetings. He has extensive experience with native tissue, graft and synthetic mesh repairs.