Surgical treatment options for vaginal prolapse are just like with stress incontinence; vaginal, abdominal, laparoscopic or robotic. Often times a combination of procedures is performed.
More often than not the laparoscopic approach is chosen, as it does have a higher success rate than the vaginal approaches. That having been said, vaginal surgeries are generally excellent choices for the patient who is of advanced age or who has medical problems which preclude the safe usage of an abdominal approach.
The abdominal sacral colpopexy has been described in the literature for at least 40 years. It has always been the “go to” surgery for apical prolapse and enterocele. The laparoscopic abdominal sacral colpopexy is now the procedure of choice for the treatment of post hysterectomy vaginal vault prolapse because of its high success rate, short operative time, low complication rate and ease of recovery for the patient (please see video under “Media”). Note that though a hysterectomy is often indicated at the time of prolapse surgery it is not always required thus, for women choosing to keep their uterus a modification of the colpopexy procedure called the addominal sacral uteropexy is an excellent choice.
The sacral colpopexy can be performed robotically but this approach involves making more incisions in the abdomen that are less cosmetic. Long term data regarding the robot is absent as well so it is impossible to know how this approach stands up to the gold standard laparoscopic approach. Still, robotic surgery is appropriate for some women such as those with a weight problem who still want to undergo minimally invasive surgery.
The bilateral sacrospinous ligament fixation is the standard vaginal surgery for treatment of vaginal prolapse (please see “Media”). Again, it is best suited for the elderly patient or those who are poor candidates for abdominal surgery.
The success rate for laparoscopic approach is generally 90%; for vaginal approach approximately 80%.