Sacral colpopexy / hysteropexy using your own tissue (fascia lata)

Laparoscopic or robot-assisted surgery for vaginal prolapse

This information has been prepared by the specialists at Urogynaecology Specialists. It is intended to help you understand your planned procedure. Please speak with your surgeon if you have any questions.

What is vaginal prolapse?

Vaginal prolapse happens when the walls of the vagina lose their support and drop out of position. It is very common. Symptoms can include:

  • A feeling of a bulge or lump in the vagina
  • Difficulty emptying your bladder or bowel
  • Constipation
  • Problems with sexual intercourse

Surgery is only recommended when prolapse is causing symptoms. Most women feel significantly better after an operation.

About this surgery

A sacral colpopexy or sacral hysteropexy is an operation to lift and support the upper vagina by attaching it to the bone at the base of your spine (the sacrum). This is done through small keyhole incisions in the abdomen using either a laparoscope or a surgical robot.

The name of the operation depends on whether you have a uterus:

  • Sacral hysteropexy — if your uterus is being kept in place. The uterus is supported and lifted without being removed.
  • Sacral colpopexy — if you have already had a hysterectomy, or if you are having a hysterectomy at the same time. In this case, the top of the vagina (the vault) is what is being supported.

Your surgeon will have discussed which procedure applies to you. If you are also having an incontinence procedure, this will be listed on your hospital consent form. Please contact your surgeon’s rooms if you have any questions.

Illustrations: sacral hysteropexy and sacral colpopexy. (Add your anatomical diagrams here using a Squarespace Image block.)

For this surgery, your own connective tissue is taken from your thigh (called fascia lata) and used as a graft instead of synthetic mesh. Using your own tissue avoids the risks associated with synthetic mesh and mesh-related complications. The trade-off is a small scar on your thigh and a longer operation.

How successful is this surgery?

Our experience is that long-term support of the vault or uterus is achieved in approximately 95% of patients. This result is supported in studies. Most women also report significant improvement in quality of life and bladder, bowel and sexual symptoms. It is important to note that the evidence base for AFL specifically is still growing, and most studies to date are from single centres with smaller numbers of patients.

What happens during the operation?

The operation is performed under general anaesthetic — you will be completely asleep.

Step 1: Harvesting your fascia lata (thigh tissue)

A strip of connective tissue is taken from your thigh — usually the left thigh, unless you prefer the right. Your surgeon will discuss the side with you beforehand and mark the area on your skin with a pen; this washes off easily in the shower.

Local anaesthetic is injected into the area, and a small horizontal cut (about 3–4 cm) is made partway down the outer thigh. A strip of tissue approximately 12 cm × 4 cm is removed and prepared for use later in the operation.

The thigh wound is closed with two layers of dissolving stitches, and a compression bandage is applied.

Illustration: fascia lata harvest — location of incision and size of strip harvested. (Add your diagram here using a Squarespace Image block.)

Step 2: The sacral colpopexy or hysteropexy

Your surgeon makes 4 small cuts in the abdomen (5–12 mm each) and uses keyhole instruments to carefully separate the bladder and bowel from the upper vagina.

  • If you are having a hysterectomy at the same time, this is performed first — the uterus is removed through the vagina, and the top of the vagina is sewn closed.
  • If you have already had a hysterectomy, your surgeon works directly with the top of the vagina (the vault).
  • If your uterus is being kept (hysteropexy), the uterus remains in place and the fascia is attached to support it.

The strip of tissue from your thigh is then stitched to the vagina or uterus and attached to a strong ligament on your sacrum, lifting and supporting the prolapse. The repair is covered with a layer of tissue (peritoneum) to protect it.

Step 3: Finishing up

Once the abdominal wounds are closed, any vaginal repair or incontinence procedure is carried out.

At the end of the operation, a small camera is passed into your bladder (cystoscopy) to check that the bladder, urethra and ureters have not been injured. A bladder catheter is placed and is usually removed 1–2 days later.

What are the risks?

General surgical risks

  • Anaesthetic risks
  • Bleeding (rarely requiring a blood transfusion)
  • Infection in the pelvis or wound (antibiotics are given to help prevent this)
  • Blood clots in the legs or lungs (DVT/PE) — you will be given medication and compression stockings to reduce this risk
  • Rarely, the keyhole approach may need to be converted to open surgery

Risks specific to the thigh harvest

  • Bruising or blood collection (haematoma) — occasionally needs drainage
  • Fluid collection (seroma) at the site
  • Pain at the harvest site
  • Scarring
  • Temporary numbness or altered sensation in the thigh — this is relatively common (affecting around 1 in 5 patients) but typically resolves on its own
  • A small visible muscle bulge (rare)
  • Blood clot in the leg (DVT) related to the harvest — rare, but reported in studies; managed with blood-thinning medication
  • Very rarely, nerve injury or reduced leg function

Risks specific to prolapse surgery

  • Bladder problems such as difficulty emptying, urinary tract infection, or leakage — these usually settle. If leakage persists, further treatment may be needed.
  • Pain after surgery — this usually resolves within days to weeks. Long-term pain is rare.
  • Injury to nearby structures (bladder, bowel, ureter, or nerves) — rare. A cystoscopy at the end of surgery checks for bladder injury.
  • Bowel obstruction or hernia — rare, and may need further surgery
  • Sexual intercourse: most women notice improvement, but around 2% experience pain with sex after surgery, which may require further treatment
  • Prolapse recurrence

Recovery

Most women stay 3 nights in hospital after this procedure and can return to work after 6 weeks. Detailed information about your recovery is provided in the UGS Recovery Information page, which you will be given a link to or can request from our rooms.

Compression shorts

We advise wearing a pair of high-compression shorts from day 2 after surgery for the first 4 weeks. These help keep pressure on your thigh wound and promote healing. Compression shorts can be purchased through our clinic. You may remove them for showering.

What are the alternatives?

  • No treatment — you may choose to manage your symptoms without surgery
  • Pelvic floor muscle training
  • Vaginal pessary — your surgeon may recommend trying this before surgery
  • Vaginal-only surgery — an alternative surgical approach
  • Laparoscopic/robotic sacral colpopexy using synthetic mesh — the traditional graft material

The RANZCOG clinical guidance on sacral colpopexy is based primarily on evidence using synthetic mesh, not fascia lata. The evidence for AFL specifically comes from smaller studies, and larger long-term research is ongoing. Your surgeon can discuss this with you in more detail. See the RANZCOG Sacrocolpopexy Clinical Guidance Statement.

References

  1. Burns et al. (2025). Medium-term outcomes for robotic sacral colpopexy with autologous fascia lata. Neurourology and Urodynamics. https://pmc.ncbi.nlm.nih.gov/articles/PMC12264459/
  2. Damiani et al. (2023). Robotic sacrocolpopexy with autologous fascia lata — case series. Gynecology and Minimally Invasive Therapy. https://pmc.ncbi.nlm.nih.gov/articles/PMC10071871/
  3. Patel et al. (2022). Total autologous fascia lata sacrocolpopexy — outcomes in 34 patients. Urology. https://pubmed.ncbi.nlm.nih.gov/36115434/
  4. Scott et al. (2019). Robot-assisted laparoscopic sacrocolpopexy with autologous fascia lata — technique and outcomes. International Urogynecology Journal. https://pubmed.ncbi.nlm.nih.gov/30707257/
  5. Latini et al. (2001). Harvesting autologous fascia lata for pelvic reconstructive surgery — techniques and morbidity. Am J Obstet Gynecol. https://doi.org/10.1067/mob.2001.119074
  6. RANZCOG Sacrocolpopexy Clinical Guidance Statement. https://ranzcog.edu.au/wp-content/uploads/2022/08/Sacrocolpopexy-clinical-guidance-statement-C-Gyn-37.pdf