Pectopexy (Pelvic Organ Prolapse Surgery)
A laparoscopic repair for a descending uterus or vaginal vault in which the suspension is attached to the strong ligament on the side wall of the pelvis (the iliopectineal ligament).
Last medically reviewed: October 6, 2026 — Assoc. Prof. Dr. Müslüm Ergün
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- Procedure time
- 60–120 minutes
- Anesthesia
- General anaesthesia
- Hospital stay
- 1–2 nights
- Stay in Türkiye
- 7–10 days
- Catheter duration
- 1 day
- Return to work
- 2–4 weeks (desk work), 6 weeks (heavy work)
- Flight clearance
- After the review appointment
About the condition
Pelvic organ prolapse is the descent of the uterus, bladder, bowel or — in women whose uterus has been removed — the vaginal vault, because the supporting tissues have weakened. Women usually describe it as "a bulge down below", "as if I am sitting on a ball", or having "to push it back to empty".
THE PRESENCE OF PROLAPSE IS NOT IN ITSELF A REASON TO OPERATE. Some women have a degree of prolapse on examination and no symptoms at all, and those women are not operated on. The decision rests on how much the symptoms restrict daily life, whether they affect bladder and bowel emptying, and on what the woman expects.
Pectopexy is a laparoscopic method in which the descending uterus or vaginal vault is suspended upwards with a mesh attached to THE STRONG LIGAMENT ON THE SIDE WALL OF THE PELVIS (the iliopectineal, or Cooper, ligament). In classical sacrocolpopexy the suspension is attached to the covering of the bone in front of the spine (the promontory).
THE PRACTICAL MEANING OF THAT DIFFERENCE IS THIS: the area in front of the spine is a confined space bordered by major vessels (the presacral vessels), the ureter and the last part of the large bowel. Because pectopexy never enters that area, it avoids the problems arising from those relations. It also does not narrow the space through which the bowel passes, so an increase in constipation after surgery is not expected. In women who are overweight, and where access to the pre-spinal area is difficult, it becomes a preferred option.
AN HONEST LIMIT: pectopexy is a newer method than sacrocolpopexy, and the pool of long-term comparative data is not as large. That should be known when deciding. If only one method is being offered to you, you are entitled to ask why the others do not suit you.
PROLAPSE AND INCONTINENCE ARE NOT THE SAME THING. In some women the prolapse kinks the urethra and masks leakage; once the prolapse is corrected, the leakage appears. Assessment before surgery therefore includes reducing the prolapse and testing for hidden incontinence, so that a sling can be planned either at the same operation or later. Skipping that step is what leads a woman to say "I started leaking after the operation".
SURGERY IS NOT THE FIRST STEP. In mild and moderate prolapse, pelvic floor physiotherapy, weight loss, treating constipation and a pessary are tried. A pessary can also serve as a lasting solution for women who do not want surgery or who are an anaesthetic risk.
Who is it suitable for?
May be suitable
- Women in whom uterine or vault prolapse causes definite symptoms
- Women who have developed vault prolapse after hysterectomy
- Women who do not wish to use a pessary, or gain no benefit from one
- Women in whom access to the pre-spinal (promontory) area is difficult
- Women with marked constipation who do not want additional burden in that respect
- Selected women in whom preserving the uterus is preferred and suitable
May not be suitable
- Women with prolapse on examination but no symptoms — surgery is not advised
- Women planning a pregnancy: delivery can undo the durability of the repair
- Women with untreated urinary or vaginal infection
- Selected women unsuitable for laparoscopy after multiple abdominal operations
- Women at high anaesthetic risk, in whom a pessary and physiotherapy are considered first
- Mild cases in which pelvic floor physiotherapy has not been tried at all
Technology used
- Laparoscopic instrument set and high-definition camera
- Synthetic or biological material for the suspension
- Objective measurement of prolapse using the POP-Q system
- Uroflowmetry and post-void residual measurement
- Testing for occult incontinence with the prolapse reduced
- Urodynamics and cystoscopy where required
Surgeon's experience
Verifiable information
- Surgeon's experience
- Assoc. Prof. Dr. Müslüm Ergün121270
Step-by-step journey
- Remotely
Initial assessment
Your symptoms, obstetric history, previous surgery (particularly hysterectomy), bladder and bowel symptoms, any gynaecological examination notes and urodynamics are reviewed.
- Day 1
Examination and tests
Gynaecological examination establishes the degree of prolapse and which compartment is involved. The prolapse is reduced and occult incontinence looked for. Uroflowmetry, residual volume, urinalysis and culture are carried out.
- Day 2
Surgery
The abdomen is entered laparoscopically and the descending uterus or vault is attached, with the suspension material, to the strong ligament on the side wall of the pelvis. Where needed, an incontinence procedure or anterior/posterior wall repair is added in the same sitting.
- Days 3–4
Discharge
The catheter is usually removed the following day and voiding is checked. Most patients go home after 1–2 nights.
- Days 5–8
Review
The wounds and the urinary stream are assessed. The return flight is planned for after this review.
- Week 6
Assessment of the result
Return to sexual activity and heavy exertion is discussed. The suspension is assessed on examination.
Method comparison
| Criterion | Pectopexy | Sacrocolpopexy |
|---|---|---|
| Point of attachment | Ligament on the pelvic side wall | Covering of the bone in front of the spine |
| Proximity to major vessels | That area is not entered | Adjacent to the presacral vessels |
| Proximity to the ureter | Further away | Closer |
| Narrowing of the bowel space | Not expected | Possible |
| Increase in constipation | Not expected | Has been reported |
| Access in overweight patients | Relatively easier | Can be difficult |
| Pool of long-term data | Newer; data more limited | Larger and established |
| Hospital stay | 1–2 nights | 1–2 nights |
This table is not a ranking. Pectopexy has anatomical advantages; sacrocolpopexy has a longer and broader data history. Tell us which trade-off matters most to you — the decision is built on that.
Risks
- RECURRENCE OF PROLAPSE: no repair guarantees a permanent result. Prolapse can recur over the years in the same compartment or in another (for example the posterior wall)
- INCONTINENCE APPEARING AFTER SURGERY: if the prolapse was kinking the urethra and masking leakage, the leakage may become evident after correction. That is why occult incontinence is tested for beforehand
- PROBLEMS RELATED TO THE SUSPENSION MATERIAL: pain, exposure through the vaginal wall (erosion), or rarely the need for removal. The material is a permanent implant and surgery should not be planned without discussing this
- Risks of laparoscopy: injury to adjacent organs (bladder, bowel, ureter), bleeding, rarely conversion to open surgery
- Urinary tract infection
- Pain during intercourse (dyspareunia)
- Formation of adhesions inside the abdomen
- Risks of general anaesthesia and of thromboembolism — reduced by early mobilisation and, where indicated, medication
Alternatives
- Observation — the first option in women with no symptoms or only mild ones
- Pelvic floor physiotherapy — can reduce symptoms in mild and moderate prolapse
- Pessary (vaginal support ring) — can also serve as a lasting option for women who do not want, or are not suitable for, surgery
- Lifestyle measures — weight loss, treating constipation, reducing heavy lifting, treating a chronic cough
- Laparoscopic sacrocolpopexy — suspension to the area in front of the spine, with a larger pool of long-term data
- Vaginal repairs — sacrospinous fixation and native tissue repair
- Colpocleisis — closure of the vaginal canal in older patients not planning intercourse and at anaesthetic risk
Recovery
First 48 hours
A sensation of gas in the abdomen and pain referred to the shoulder are usual after laparoscopy. Early walking is encouraged; it both helps the gas disperse and lowers the risk of clots.
Week 1
Ordinary daily activities are possible. Lifting, straining and long periods standing are avoided. Constipation is prevented — straining is the most damaging thing in the first weeks of a repair.
Weeks 2–4
Return to desk work usually falls here. Walking is free; running, weights and abdominal exercise wait.
Week 6
Return to sexual activity is usually discussed after this point and after the review appointment.
Month 3
The change in the sense of bulging and pressure can be judged clearly.
Long term
Weight control, preventing constipation and pelvic floor exercise all help preserve the result. A new prolapse can develop in another compartment over the years; regular review is advised.
Frequently asked questions
I have prolapse but no symptoms — should I be operated on?
No. Women found to have prolapse on examination but who are not troubled by it are not operated on. The decision rests on how much your symptoms restrict your daily life.
Will my uterus be removed?
In suitable cases pectopexy can be performed with the uterus preserved. Whether it is removed is decided together, according to the type of prolapse, any accompanying gynaecological problem, and your own preference.
Which is better, pectopexy or sacrocolpopexy?
The question is not "which is better" but "which trade-off suits you". Pectopexy avoids the vessels and bowel in front of the spine and is not expected to worsen constipation; sacrocolpopexy has a longer and broader data history. Advice that does not state both sides is incomplete.
Will I start leaking after the operation?
It is possible if the prolapse was kinking the urethra and masking leakage. That is why the prolapse is reduced and occult incontinence tested for before surgery; if needed, a sling is planned at the same operation or later. A plan that skips this step is incomplete.
Is the material used safe?
The suspension material is a permanent implant. It can rarely cause pain, exposure through the vaginal wall (erosion) or the need for removal. If a surgeon takes you to theatre without discussing these risks, seek a second opinion.
Can the prolapse come back?
Recurrence is possible, and no method can guarantee a permanent result. Weight gain, constipation, chronic cough and heavy lifting raise that chance. Managing those factors after the repair directly affects how long it lasts.
Will it affect my sex life?
In most women the effect is positive, because the sensation of bulging goes. Return to sexual activity is usually discussed after six weeks and after the review. Report any pain during intercourse without delay.
Should I try a pessary?
In mild and moderate prolapse, and in women who do not want surgery or are at anaesthetic risk, a pessary is a legitimate option and can be used long term. It requires regular review and cleaning.
When can I go back to work?
Usually 2–4 weeks for desk work. For jobs involving heavy lifting, 6 weeks. Straining and lifting early on put the repair under direct strain.
How long should I stay in Türkiye?
Usually 7–10 days. Because the review is carried out here, plan your return flight for after that appointment.
What documents should I send?
Gynaecological examination notes and any POP-Q measurement, urodynamics, uroflowmetry and residual volume, reports of previous surgery (especially hysterectomy), a urinalysis and your medication list.
Articles on this topic
Scientific sources
This page is for general information only and is not a substitute for medical advice.
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