Pelvic organ prolapse is a common condition affecting women, especially after hysterectomy, childbirth, or in advanced age. One of the more severe forms is vaginal vault prolapse, where the top of the vagina descends due to loss of support from pelvic ligaments and fascia. This condition can cause bothersome symptoms such as pelvic heaviness, urinary dysfunction, difficulty with bowel movements, and impaired sexual function. Among the various surgical techniques available, laparoscopic sacrocolpopexy has emerged as the gold standard for durable repair of vaginal vault prolapse, combining effectiveness with the advantages of minimally invasive surgery.

Understanding Vaginal Vault Prolapse

After hysterectomy, the upper portion of the vagina, or vaginal cuff, may lose its anchorage to the surrounding supportive tissues. Over time, gravity, increased intra-abdominal pressure, and weakened pelvic floor muscles contribute to the downward displacement of the vaginal vault. The condition may present as a bulge or lump at the vaginal opening, accompanied by discomfort, urinary incontinence, incomplete bladder emptying, constipation, or sexual difficulties. Without treatment, prolapse can significantly impair quality of life.

What is Laparoscopic Sacrocolpopexy?

Sacrocolpopexy is a surgical procedure designed to restore normal vaginal anatomy by attaching the vaginal vault to the sacrum (the lower backbone) using a synthetic mesh. The laparoscopic approach utilizes small incisions, a high-definition camera, and specialized instruments, providing the same durable results as open surgery but with reduced morbidity. By suspending the vagina in its normal anatomical position, the procedure restores pelvic support and alleviates symptoms of prolapse.

Surgical Technique

The surgery is performed under general anesthesia and involves the following steps:

Creation of Pneumoperitoneum
After inserting trocars, the abdomen is insufflated with carbon dioxide to create working space.

Exposure of Pelvic Anatomy
The surgeon dissects the peritoneum to expose the sacral promontory (the upper part of the sacrum) and the vaginal vault.

Placement of Mesh
A Y-shaped synthetic mesh is commonly used. The lower arms of the mesh are sutured securely to the anterior and posterior vaginal walls, providing support to the vaginal cuff.

Fixation to the Sacrum
The upper end of the mesh is anchored to the sacral promontory with non-absorbable sutures. This fixation restores the vagina to its natural axis and position.

Peritoneal Closure
The peritoneum is closed over the mesh to prevent exposure to abdominal contents, reducing the risk of complications like bowel adhesion.

The laparoscopic procedure typically lasts 2–3 hours and is associated with less blood loss, less postoperative pain, and quicker recovery compared to open surgery.

Advantages of Laparoscopic Sacrocolpopexy

Durable Repair
Sacrocolpopexy is considered the most reliable procedure for vault prolapse, with long-term success rates exceeding 90%.

Restoration of Vaginal Function
By maintaining vaginal length and axis, this surgery preserves sexual function, unlike some obliterative procedures.

Minimally Invasive Benefits
Smaller incisions lead to less pain, reduced risk of infection, shorter hospital stays, and faster return to normal activities.

Improved Quality of Life
Relief from bulge symptoms, urinary problems, and bowel dysfunction translates into significant improvement in daily comfort and confidence.

Risks and Complications

Like all surgical procedures, laparoscopic sacrocolpopexy carries certain risks. These include bleeding, infection, injury to surrounding organs such as the bladder, ureters, or bowel, and mesh-related complications. Mesh erosion into the vagina, though uncommon, may require further treatment. Rarely, patients may experience recurrence of prolapse or new onset of urinary incontinence. However, with meticulous surgical technique and appropriate patient selection, complications are relatively low.

Postoperative Care

Most patients stay in the hospital for 2–3 days following surgery. Postoperative care involves:

Pain management with oral medications.

Gradual diet progression and encouragement of mobility to prevent deep vein thrombosis.

Avoidance of heavy lifting, straining, or sexual activity for at least 6–8 weeks.

Pelvic floor physiotherapy to enhance muscle strength and support the surgical repair.

Regular follow-up visits to monitor healing and ensure long-term success.

Who is an Ideal Candidate?

Laparoscopic sacrocolpopexy is most suitable for women with symptomatic vault prolapse who wish to preserve vaginal function. It is often recommended for younger and sexually active women, as it maintains vaginal length and elasticity. Patients with recurrent prolapse after previous surgeries may also benefit from this procedure.

Conclusion

Laparoscopic sacrocolpopexy represents the gold standard surgical approach for treating vaginal vault prolapse. By combining the effectiveness of mesh-based suspension with the advantages of minimally invasive surgery, it restores normal anatomy, alleviates symptoms, and enhances quality of life. Although the procedure requires advanced surgical expertise, its long-term durability and functional outcomes make it a preferred choice worldwide. For women struggling with the distressing symptoms of vault prolapse, laparoscopic sacrocolpopexy offers a safe, effective, and life-changing solution.