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Operation: Sacrocolpopexy

Insurance code: P2420

Introduction: This information is written by John Fairbank and is provided for the benefit of his patients. Additional information will be given during consultation in the clinic and during the pre-operative discussion. It is not appropriate for all surgeons’ individual practice or for all patients.

Purpose of operation Abdominal sacrocolpopexy is carried out to repair a prolapse that involves descent of the top of the vagina. This type of prolapse is commonest after a previous hysterectomy.

Description of procedure
A catheter is placed in the bladder to drain off all the urine and protect the bladder from surgical damage. The abdominal cavity is opened through a transverse supra-pubic (bikini line) or midline vertical abdominal incision. The bladder is reflected off the top of the vagina. A number of stitches are used to insert a piece of synthetic mesh which attaches the top of the vagina to the tissue immediately in front of the lower part of the vertebral column. The vagina is therefore suspended from above.

Anaesthetic These operations are usually carried out under general anaesthetic.

Length of stay A ‘bikini’ line incision normally allows for a four night stay and a vertical midline incision normally requires a five night stay.

Post-operative management The catheter is normally removed the following day. The IV fluid line is left in place until oral fluids are tolerated. The painkilling pump is kept in place until it is no longer required. Stitches or skin staples are normally removed the days of discharge from hospital.

Potential complications
Complications at the time of surgery include peri-operative bleeding. This bleeding can rarely be quite heavy and require a blood transfusion. The ureters run close to the operation site and can rarely be obstructed during the surgery requiring further attention.These complications are rare but require corrective surgery immediately or as soon as a problem is recognised. Venous thrombosis (DVT) can follow any pelvic surgery. Stockings are therefore worn and heparin injections given each day to reduce the risk. Early mobilisation and early discharge from hospital reduce the risk of thrombosis. The mesh can sometimes work its way through the vaginal skin and cause discharge and an offensive smell. The mesh sometimes then requires removal from below. The prolapse will often remain supported even after the mesh is removed due to the adhesions that have formed.

Post-operative consultation
A routine appointment is normally booked for six weeks to ensure the vagina is well healed although other appointments may be necessary to ensure the post-operative course goes smoothly.

Other considerations
Sex is best avoided until the skin has healed and sutures have dissolved. This may take up to nine weeks. Heavy lifting is best avoided for three months to prevent stitches giving way but light lifting is not a problem. Driving short distances is practical once comfortable and strong sedative pain killers are no longer being taken.

The alternative operation for this type of prolapse is called a sacrospinous fixation. This operation can usually be carried out through the vagina and is a better choice in most cases of vault prolapse.

Relevant websites

Information on the surgical repair of prolapse.

Information on some issues related to vaginal prolapse repair surgery.