Colpopexy is a surgical procedure used to reposition a woman’s vagina that has moved from its correct physical location. Women may experience what is known as vaginal prolapse, where the vaginal structure weakens and falls in on itself; it may even protrude externally through the vaginal opening. This is a fairly common occurrence in women who have had a hysterectomy, though it can also happen as a result of menopause or childbirth. The procedure, also called vaginopexy or vaginofixation, involves attaching the vagina to surrounding tissue in the abdomen to hold it in place. There are two major types of colpopexy, abdominal sacral colpopexy and vaginal sacrospinous colpopexy.
Vaginal sacrospinous colpopexy is performed transvaginally, meaning entry to the body is made through the vagina itself. This allows repairs to be made in a minimally invasive fashion. The vagina is sutured to the sacrospinous ligament to hold it in place. Sometimes a vaginal hysterectomy may be done at the same time to limit the risk of recurring prolapse.
Abdominal sacral colpopexy is a more invasive approach that involves an incision in the abdominal wall. The vagina is repositioned to the appropriate location and then mesh is sutured in place to support it. The mesh can be made of synthetic material, or the patient’s own fascia may be used, depending on the surgeon’s preference. Despite the fact that it is a more invasive procedure than the sacrospinous suspension approach, research indicates that it may be more successful long term in preventing a recurrence of vaginal prolapse. In some instances, the sacrospinous procedure may be tried first, but if it is unsuccessful in keeping the vagina in place, then the abdominal sacral surgery is used.
As with any surgery, there are risks involved with colpopexy. The surgeon needs to be careful of the many surrounding structures, such as the urethra, bladder, and rectum, to ensure they are positioned correctly in relation to the vagina; correct positioning of the mesh in the abdominal sacral procedure is also vital to avoid damaging nearby tissue and organs. Infection at the surgical site is always a possibility. Vaginal sacrospinous attachment that is not done properly may put pressure on nerves in the area and cause pain. There is also a risk that the mesh or sutures used to support the vagina may erode over time and need to be repaired or replaced.