Laparoscopic sacrocolpopexy

Summary

A sacrocolpopexy is an operation for prolapse of the top of the vagina — the vault, which can descend after the womb has been removed, or the womb and cervix themselves when they have come down. A narrow strip of mesh is attached to the top of the vagina and to the strong ligament over the base of the spine (the sacrum), lifting the vagina back to its natural position and holding it there. In the laparoscopic approach this is done through small cuts.

• It is the most durable operation for vault prolapse, and restores the natural axis of the vagina.
• Done under general anaesthetic through four small cuts (one 10 mm and three 5 mm), and takes longer than most keyhole gynaecological operations.
• It uses a mesh — placed in the abdomen, not in the vagina. This is a different situation from vaginal mesh, and is explained in its own section below.
• Where the womb is kept, the same operation is called a sacrohysteropexy.
• Avoid heavy lifting and straining for 4–6 weeks while the mesh becomes incorporated.

This information supports discussion with your healthcare team. Reading, saving or printing it does not constitute consent to surgery.

About the operation

The top of the vagina is normally held up by ligaments running back towards the sacrum. When those ligaments fail — most often after a hysterectomy, sometimes with age or after childbirth — the vault descends, and can eventually turn inside out. Repairing a vaginal wall does not fix this; the support has to be re-created at the top.

In a sacrocolpopexy the surgeon attaches a narrow strip of mesh to the front and back of the vaginal vault, passes it back over the pelvic brim, and fixes the other end to the strong ligament lying over the sacrum. The mesh is then covered by the peritoneum — the lining of the abdomen — so it lies away from the bowel and is not exposed inside the vagina. The vagina is suspended, not pulled tight: the aim is to restore its normal length and direction.

Two variations may be discussed with you:

• Sacrohysteropexy — the same suspension with the womb kept in place, for women whose womb has come down but who wish to keep it.
• Combined with a vaginal repair — where a wall bulge is also present, an anterior or posterior repair may be done at the same time.

About the mesh

You may have read about problems with mesh used in gynaecological surgery. That reporting concerns vaginal mesh and mesh tapes placed through the vagina, where the mesh sits directly beneath vaginal skin. Sacrocolpopexy is a different operation: the mesh is placed inside the abdomen, attached to the vault and the sacrum, and covered by the abdominal lining.

• The mesh is a permanent implant. It becomes incorporated into your own tissue over the following months.
• The specific complication associated with mesh — the mesh working its way through the tissue and becoming exposed (erosion or extrusion) — is possible here too, but is uncommon with this route.
• If it happens, it is treated; occasionally part of the mesh has to be removed.
• Mesh-free alternatives exist, though they are rarely used now; they are listed below. If you would prefer not to have a mesh implant, say so — it is a reasonable position and there are options.

The mesh used for this operation is usually available and affordable in Sri Lanka. Ask your surgeon what is used in your case, and make sure you are content with a permanent implant before you consent.

Why it is performed

This operation is performed by Dr Mathota at most of the major private hospitals. It is considered when prolapse of the vault or of the womb is troubling you and simpler measures have not been enough — that is, when:

• The top of the vagina has descended after a previous hysterectomy — a bulge, a dragging sensation, or in advanced cases the vagina turning outwards
• The womb has come down and you wish to keep it (sacrohysteropexy)
• A pessary is not suitable, will not stay in place, or you do not wish to continue with one
• A previous prolapse repair has failed, or the prolapse is advanced, where a durable suspension is needed
• You are sexually active and the length and direction of the vagina matter — this operation preserves both better than the vaginal alternatives

Benefits

• The most durable repair for vault prolapse — it lasts longer than the vaginal operations for the same problem, which is why it is preferred where longevity matters.
• The vagina keeps its natural length and direction, so sex is generally unaffected or improved — an advantage over vaginal suspensions, which can shorten or angle the vagina.
• No mesh inside the vagina — the mesh lies in the abdomen, covered by the abdominal lining.
• Compared with the open operation: smaller cuts, less pain, a shorter stay and a faster return to normal activity, with the same suspension.
• Can be combined with a vaginal wall repair in one anaesthetic where that is needed.

Alternatives

• No treatment for now — a prolapse that does not trouble you needs no operation.
• Vaginal pessary — a support device worn in the vagina, changed periodically in clinic; effective for many women and avoids surgery altogether.
• Pelvic floor muscle training — helpful for symptoms, though it will not lift an established vault prolapse.
• Mesh-free operations — sacrospinous fixation and uterosacral ligament suspension use your own ligaments instead of an implant, and colpocleisis closes the vagina for frail patients who do not wish to be sexually active. These are rarely used now, but can be discussed if you would prefer to avoid an implant.
• Vaginal hysterectomy with repair — where the womb is the main problem; see our vaginal hysterectomy guide.

Preparing for surgery

Before the operation you will have a pre-operative assessment: blood tests, blood pressure checks, and a review of your medicines and general health, together with a vaginal examination to plan the suspension and any repair needed. Tell the team about all medicines you take — blood thinners may need adjusting — and about all previous surgery, particularly your hysterectomy and any previous prolapse operation.

• Cough and constipation: treating either beforehand protects the repair.
• Vaginal oestrogen may be prescribed beforehand to improve tissue quality if you are past the menopause.
• Bowel preparation is used before this operation, since it works close to the bowel; you will be given instructions.
• Fasting: exact instructions are given; typically no food from 6 hours before, water up to 2 hours before.
• At home: arrange help for the first two weeks and plan to avoid lifting.

The day of surgery

You are usually admitted on the day of surgery. The team confirms your identity and the planned operation, and you meet the anaesthetist and the surgeon. This is the time for last questions.

You will be asked to sign the consent form, which records the operation, its intended benefits and its risks as they apply to you — including the use of a permanent mesh implant, whether the womb is being kept, whether a vaginal repair is planned, and what should happen if keyhole surgery cannot safely be completed. You can still change your mind at this point. Compression stockings are usually fitted and antibiotics are given at the start of surgery.

During the operation

The operation is done under general anaesthetic — you are fully asleep and feel nothing. A catheter is placed, and an instrument is used in the vagina to help the surgeon identify the vault accurately.

The abdomen is gently inflated with carbon dioxide gas to create space to operate. Four small cuts are used — one of 10 mm for the camera and three of 5 mm for the instruments. The surgeon exposes the top of the vagina front and back, and the ligament over the sacrum — working carefully here, since the ureter and important blood vessels lie close by. The mesh is secured to the vault, laid back along the pelvis without tension, and fixed to the sacral ligament so that the vagina is lifted to its natural position. The abdominal lining is then closed over the mesh so that it is covered along its whole length. Any vaginal repair is done at the same sitting. The gas is let out and the small cuts closed with dissolvable stitches.

Occasionally, if keyhole surgery proves unsafe to continue — because of dense scarring from previous surgery, or bleeding near the sacrum — the surgeon completes the operation as an open operation for your safety. Very rarely the suspension has to be abandoned in favour of a different technique; this possibility is discussed with you before consent.

After the operation

By the time you wake, the operation is complete. Some shoulder-tip pain is common for a day or two — it comes from the gas used during surgery and settles on its own; walking about helps.

• Pain relief: regular painkillers control most discomfort; stronger medication is available if needed.
• Catheter: usually removed the day after surgery; the team then checks that you are passing urine satisfactorily.
• Eating and drinking: usually the same day, starting with fluids. Bowel movements may take a few days to return to normal, as the operation works close to the bowel.
• Moving: up and about the same day or the next morning — early walking speeds recovery and protects against clots.
• Going home: usually the day after surgery.

Recovery at home

• Week 1: rest, alongside your normal day-to-day activities. Tiredness is normal.
• Week 2 onwards: build your activity up steadily.
• Lifting and straining: avoid both for 4–6 weeks while the mesh becomes incorporated into your tissue. Treat constipation promptly.
• Driving: once you can brake hard without hesitation — commonly around 2 weeks.
• Sex: usually after about 6 weeks, when healing is complete.
• Exercise: walking first; strenuous exercise and heavy physical work from about 6 weeks.
• Pelvic floor exercises: restart once healing allows.
• Long term: avoiding repeated heavy lifting and treating a chronic cough or constipation protects the repair for years to come.

This guidance covers what is usual after keyhole surgery; the advice given to you personally takes precedence.

Risks and complications

Every operation carries risk. The figures below are averages from published UK guidance; your individual risk depends on your age, weight, other conditions and previous surgery, and will be discussed with you.

Expected, temporary effects

• Pain and tiredness in the first days; shoulder-tip pain from the gas
• Bruising around the small cuts
• Slow bowel function and mild bloating for a few days

Complications

• Mesh exposure or erosion — the mesh working through into the vagina, causing discharge, bleeding or discomfort. Uncommon with the abdominal route, but the complication specific to using a mesh; treated when it occurs, occasionally by removing part of the mesh.
• Bleeding — the veins over the sacrum can bleed briskly; occasionally a transfusion is needed (uncommon).
• Injury to the bladder, bowel or ureters — recognised injuries are repaired at the time (rare).
• Infection — of the urine or the wounds; antibiotics are given during surgery and most cases are minor.
• Blood clots in the leg or lung (VTE) — preventive measures are routine (uncommon).
• New or worse bladder symptoms — urgency, or stress leaking that becomes apparent once the prolapse is corrected (uncommon).
• Constipation or difficulty emptying the bowel, from operating close to the bowel and rectum (uncommon).
• Back or buttock pain where the mesh is fixed to the sacrum (uncommon).
• Prolapse elsewhere in the vagina — supporting the top can leave a wall bulge to be dealt with later (uncommon).
• Recurrence of the vault prolapse — less likely than with the vaginal alternatives, but possible.
• Conversion to open surgery during the operation, for safety (uncommon).
• Anaesthetic risks — serious anaesthetic complications are rare.

When to seek help

After you go home, seek medical advice the same day if you notice:

• Fever (38 °C or higher) or feeling increasingly unwell
• Worsening abdominal pain not controlled by your painkillers
• Persistent vomiting, or a swollen, tight abdomen with no bowel movement
• Heavy vaginal bleeding, or foul-smelling vaginal discharge
• Being unable to pass urine, or burning on passing urine
• A wound that becomes red, swollen, hot or leaks fluid
• A painful, swollen or red leg

In the longer term, tell your doctor about any new vaginal discharge, bleeding or discomfort during sex — these can be the first signs of mesh exposure, which is treatable.

Preparing for your consent discussion

Consent is a conversation, not a signature. Because this operation places a permanent implant, you should feel you understand why a mesh suspension is recommended for you rather than a mesh-free alternative, and what would happen if there were a problem with the mesh. The checklist below is a starting point — print it and bring it to your consultation.

Sources and review

This page was drafted against the published guidance below. Each reference was live when checked; dates will be confirmed at clinical review.

1. National Institute for Health and Care Excellence. Urinary incontinence and pelvic organ prolapse in women: management. NICE guideline NG123. Available from: https://www.nice.org.uk/guidance/ng123 [last checked 29 July 2026].
2. Royal College of Obstetricians and Gynaecologists. Consent advice — browse all guidance. London: RCOG. Available from: https://www.rcog.org.uk/guidance/browse-all-guidance/consent-advice/ [last checked 29 July 2026].
3. National Health Service (UK). Pelvic organ prolapse — treatment. Available from: https://www.nhs.uk/conditions/pelvic-organ-prolapse/treatment/ [last checked 29 July 2026].

Patient information from our own clinics

There is no Sugabi or vog.lk article on this topic yet. Related reading:

1. Sugabi Clinic Ragama. Anterior and posterior vaginal repair — Surgery Guide. Available from: https://sugabi.lk/surgery-guide/anterior-and-posterior-repair/