A sacrocolpopexy is a surgical procedure that corrects pelvic organ prolapse by attaching the top of the vagina to the sacrum (the bone at the base of the spine) using a piece of surgical mesh. The mesh acts as a synthetic ligament, lifting the vagina back into its normal anatomical position. It’s considered the gold standard for repairing prolapse at the top of the vagina, with anatomical success rates around 95% at three years.
How the Procedure Works
During a sacrocolpopexy, the surgeon first separates the bladder and rectum from the vaginal walls to create space for the mesh. A piece of surgical mesh is then placed along the front and back walls of the upper vagina. The other end of the mesh is attached to a tough ligament that runs along the front of the sacrum, called the anterior longitudinal ligament, at roughly the level of the first sacral vertebra. Because the sacrum sits higher than the vagina, the mesh creates an upward pull that suspends the vaginal vault in its correct position.
This approach is typically recommended for women with symptomatic prolapse at stage II or higher on the clinical grading scale, meaning the pelvic organs have descended noticeably enough to cause symptoms like pressure, bulging, or difficulty with bladder and bowel function.
Open, Laparoscopic, or Robotic
Sacrocolpopexy can be performed three ways: through a large abdominal incision (open), through small incisions using a camera and long instruments (laparoscopic), or through small incisions with the assistance of a robotic surgical system. The open approach has largely given way to the minimally invasive options, which involve less pain and shorter hospital stays.
Operating times for laparoscopic and robotic approaches are similar. Laparoscopic sacrocolpopexy averages about 180 minutes of actual operative time, while robotic-assisted cases average around 194 minutes. The robotic system gives the surgeon a magnified 3D view and instruments that can rotate more freely than the human wrist, which some surgeons find helpful in a tight surgical space like the pelvis. Outcomes between the two minimally invasive approaches are comparable.
Why Mesh Is Still Used Here
If you’ve heard about the FDA pulling mesh products off the market, here’s the important distinction: that 2019 order applied only to mesh placed through the vagina. The FDA has stated clearly that “the safety and effectiveness of abdominal placement of surgical mesh for apical POP repair are well established.” Mesh placed abdominally during sacrocolpopexy results in lower complication rates than the transvaginal mesh products that were banned.
Compared to traditional vaginal surgery without mesh, sacrocolpopexy results in less recurrent prolapse. The median rate of vaginal mesh erosion (where mesh works through the vaginal tissue) is about 4% within the first two years after surgery, which is significantly lower than what was seen with transvaginal mesh products.
Success Rates and Satisfaction
A three-year follow-up study of laparoscopic sacrocolpopexy found an anatomical success rate of 94.9%, meaning the prolapse stayed corrected. Among the small number of recurrences (about 5%), most involved the front vaginal wall (the bladder side) rather than the top of the vagina where the mesh is anchored.
Patient satisfaction tends to be high. In that same study, 86.5% of women reported being fully satisfied with the outcome, while about 8% were moderately satisfied, often due to issues like new stress incontinence or mesh erosion. The remaining 5% were unsatisfied, generally corresponding to those with recurrent prolapse.
Risks and Complications
Like any surgery, sacrocolpopexy carries risks of bleeding, infection, and injury to surrounding organs. The complications specific to this procedure mostly relate to the mesh itself.
- Mesh erosion: The most common mesh-specific problem, occurring in roughly 4% of cases. This is when a small area of mesh becomes exposed through the vaginal wall. It can cause discharge, spotting, or pain during intercourse. Small erosions are sometimes managed conservatively, while others require a minor procedure to trim the exposed mesh and close the tissue.
- Pain or discomfort during intercourse: Some women experience new pain with intercourse after the procedure. Among those who do need revision surgery for mesh complications, up to 50% report persistent pain or discomfort afterward.
- New urinary incontinence: Some women develop stress incontinence after prolapse repair, even if they didn’t have it before. This happens because correcting the prolapse can unmask bladder issues that the prolapse was physically blocking.
- Recurrent prolapse: While the mesh anchoring point at the sacrum tends to hold well, prolapse can recur in a different compartment of the vagina, particularly the front wall near the bladder.
When mesh complications do require reoperation, outcomes are mixed. One study found that about 29% of women treated for mesh complications reported the same or worse symptoms two years later, which underscores why the initial surgery and mesh placement technique matter.
What Recovery Looks Like
Most women go home the same day or after one night in the hospital following a minimally invasive sacrocolpopexy. The first two weeks involve limited activity as incision sites heal and internal swelling subsides. You’ll be told not to place anything in the vagina for six weeks to allow the surgical site to heal fully.
The timeline for returning to lifting, exercise, and high-impact activities is increasingly individualized rather than based on rigid rules. Some pelvic surgery programs now encourage patients to resume activities like lifting, running, and exercise as soon as they feel strong enough, rather than imposing blanket restrictions for a set number of weeks. Most women return to desk work within two to four weeks, with physically demanding jobs taking longer. Full healing of the mesh into the surrounding tissue takes several months, even if you feel functionally recovered well before that.
Sacrocolpopexy vs. Other Prolapse Repairs
The main alternative is native tissue repair, where a surgeon uses your own tissue and sutures (no mesh) to support the vagina, typically done entirely through the vagina. This approach avoids mesh-related risks but has higher rates of prolapse recurrence over time, which is why sacrocolpopexy is generally preferred for younger, more active women and for more advanced prolapse.
Your anatomy, the severity of prolapse, whether you’ve had a prior hysterectomy, and your overall health all factor into which approach makes the most sense. Women with significant medical conditions that make longer surgery risky may be better candidates for a shorter vaginal procedure, while those who can tolerate a longer operation and want the most durable repair tend to be steered toward sacrocolpopexy.