Sacrocolpopexy

Definition and purpose

Scrocolpopexy is an operation with an abdominal approach (open, laparoscopic or robotic) to reconstruct the pelvic floor, the purpose of which is to fix the vagina to the pelvis, correct prolapse of the vaginal apex/apical prolapse/central prolapse (vaginal vault prolapse), which usually occurs after a hysterectomy. Similar operations are called sacrocervicopexy and sacrohysteropexy, which fix the cervical stump or uterus to the pelvis. The operation is considered the gold standard among operations for anatomical reconstruction of apical support.

Indications

The procedure is performed in women with:

Symptomatic prolapse of the vaginal apex (with or without prolapse of the vaginal walls)
Uterine prolapse in cases where the uterus is removed as part of the operation
failure of conservative treatments (such as physical therapy exercises or Pesari)
Desire for a long-term solution with a low recurrence rate

Surgical Technique

The procedure is performed using an open, laparoscopic or robotic method.

During the surgery, a posterior and anterior synthetic mesh is attached to the walls of the vagina, and anchored to the anterior longitudinal ligament located in front of the scrum bone (at S1-S2 level) using non-absorbable sutures. After placement, the mesh is usually covered with peritoneum to reduce complications.

Success Rates

The anatomical success rates of scrocolpopexy are high - about 85-95% over the years, with a significant improvement in symptoms and quality of life as well. The recurrence rate is lower compared to vaginal techniques, especially in advanced apical prolapses.

Possible Complications

Early: bleeding, damage to the bladder, urethra or intestine, infection.
Late: pelvic pain, dyspraxia, network failure (erosion/exposure), adhesions, intestinal obstruction.
Mesh: mesh complications occur in 2-10% of cases and sometimes require additional surgical intervention.
Specific complications for the laparoscopic/robotic approach: long operating time, need for learning and advanced technology, but with faster recovery and fewer infections.

Summary

Scrocolpopexy is an effective and proven surgical solution for prolapse of the vaginal apex, with a high success rate over time. Accurate selection of patients and adherence to correct surgical technique are essential for minimizing complications and achieving optimal results.