Vault prolapse is a form of pelvic organ prolapse that occurs when the vaginal apex (vault) descends following a hysterectomy. It is a distressing condition that affects a woman’s quality of life, leading to pelvic pressure, vaginal bulging, urinary dysfunction, bowel symptoms, and sexual difficulties. Among the surgical options available, laparoscopic sacrocolpopexy has emerged as a gold-standard procedure because it provides long-lasting support, restores normal anatomy, and preserves vaginal function with minimal invasiveness.

Understanding Vault Prolapse

Vault prolapse results from the weakening of the pelvic support structures—especially the uterosacral and cardinal ligaments—after the uterus is removed. Without adequate support, the vaginal vault gradually descends, sometimes associated with cystocele (bladder prolapse), rectocele (rectal prolapse), or enterocele (small bowel herniation).

Symptoms may include:

Vaginal bulge or mass sensation

Pelvic heaviness and dragging pain

Difficulty with sexual intercourse

Urinary problems such as incontinence or frequency

Constipation or incomplete bowel evacuation

Risk factors include:

Prior hysterectomy (especially for prolapse)

Advanced age

Multiparity and vaginal deliveries

Obesity and chronic straining

Weak connective tissue or prior pelvic floor surgeries

Why Laparoscopic Sacrocolpopexy?

Traditionally, sacrocolpopexy was performed via open abdominal surgery. However, laparoscopy has now replaced it in most advanced centers because of its clear benefits:

Minimally invasive – Smaller incisions, less blood loss, and reduced postoperative pain.

Enhanced visualization – High-definition magnified view aids precise dissection and mesh placement.

Durable results – Provides long-term correction with low recurrence rates.

Preserves vaginal function – Maintains normal vaginal length, axis, and sexual function.

Faster recovery – Shorter hospital stay and quicker return to normal activities.

Surgical Technique of Laparoscopic Sacrocolpopexy
Preoperative Preparation

Performed under general anesthesia.

Prophylactic antibiotics are given.

The patient is positioned in lithotomy with Trendelenburg tilt.

Port Placement

A 10 mm umbilical port for the laparoscope.

Two or three additional 5 mm working ports in the lower abdomen.

Dissection

The vaginal vault is identified, and peritoneal dissection is carried out over the anterior and posterior vaginal walls.

The rectovaginal and vesicovaginal spaces are carefully dissected to prepare for mesh attachment.

Mesh Placement

A Y-shaped synthetic mesh (commonly polypropylene) is introduced.

The anterior arm of the mesh is fixed to the anterior vaginal wall, and the posterior arm to the posterior vaginal wall using non-absorbable sutures.

Sacral Attachment

The peritoneum over the sacral promontory is incised, exposing the anterior longitudinal ligament.

The mesh tail is sutured securely to this ligament, providing strong support.

Peritoneal Closure

The peritoneum is closed over the mesh to reduce the risk of bowel adhesions.

Ports are removed, and incisions closed.

Postoperative Care

Pain management: Oral analgesics are usually sufficient.

Hospital stay: Most patients are discharged within 24–48 hours.

Mobilization: Early ambulation is encouraged to prevent thrombosis.

Diet: Normal diet resumed once bowel function returns.

Restrictions: Avoid heavy lifting and sexual intercourse for 6–8 weeks.

Outcomes and Success

Laparoscopic sacrocolpopexy has proven to be one of the most successful procedures for vault prolapse.

Success rate: Over 90% long-term anatomical correction.

Recurrence: Much lower compared to vaginal procedures such as sacrospinous fixation.

Sexual function: Preserves vaginal length and improves sexual satisfaction.

Quality of life: Significant improvement in pelvic floor symptoms and overall well-being.

Complications and Considerations

While generally safe, the procedure requires advanced laparoscopic skills. Potential complications include:

Bleeding or vascular injury during sacral dissection

Mesh erosion into the vagina (rare with proper technique and quality mesh)

Injury to bladder, bowel, or ureters during dissection

Constipation or sacral pain postoperatively

Recurrence in a small proportion of cases

With meticulous technique, complication rates remain low.

Conclusion

Laparoscopic sacrocolpopexy is the gold-standard procedure for vault prolapse, offering durable anatomical restoration, functional improvement, and minimal invasiveness. By using a synthetic mesh to anchor the vaginal vault to the sacral promontory, it restores pelvic support effectively while maintaining vaginal function.

At advanced institutions like World Laparoscopy Hospital, under the expertise of surgeons such as Dr. R. K. Mishra, this procedure is performed with precision, safety, and adherence to global best practices. For women suffering from vault prolapse, laparoscopic sacrocolpopexy offers a reliable and long-lasting solution, restoring quality of life and confidence.