Pectopexy Surgery
Pectopexy Surgery in Pune
Pectopexy is a laparoscopic (keyhole) surgery to treat pelvic organ prolapse by suspending the uterus or vaginal vault to the iliopectineal ligament — a firm ligament on the inner surface of the pelvic bone — using a short strip of surgical mesh. It is an alternative to sacrocolpopexy, which attaches to the sacral bone. Pectopexy avoids dissection near the sacral blood vessels (presacral space), making it technically safer and faster, with comparable long-term results.
Dr. Ammbalal Gurram performs pectopexy in Pune at Manipal Hospital Baner and Ashwinii Nursing Home Thergaon (PCMC). MBBS, DGO, DNB. Fellowship in advanced laparoscopic and robotic pelvic surgery. 26 years experience. 98% surgical success rate.
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The Problem: Pelvic Organ Prolapse
The pelvic organs — uterus, bladder, and rectum — are held in place by a network of ligaments, muscles, and connective tissue. When this support weakens after multiple childbirths, with age, or after menopause, one or more organs can descend from their normal position into or beyond the vaginal canal. This is pelvic organ prolapse (POP).
Women in Pune, Baner, Thergaon, Pimpri-Chinchwad, Wakad and across PCMC present to Dr. Gurram’s clinics with varying grades — from a feeling of heaviness that worsens by evening to a visible bulge that prevents normal daily activity. Pectopexy is one of the most effective surgical solutions for apical prolapse — where the top of the vagina or the uterus itself has descended.
Symptoms That Bring Patients to Dr. Gurram's Clinic in Baner & Thergaon
- Pelvic pressure or heaviness that builds through the day and eases when lying down
- A bulge or lump felt or seen at the vaginal opening
- Difficulty emptying the bladder fully — needing to push the bulge back to urinate
- Urinary leakage when coughing, sneezing, or standing
- Dragging lower back pain — worsens after log periods of standing or walking
- Reduced ensation or discomfort during sex
- Difficulty with bowel movements — straining, incomplete emptying
What Is Pectopexy and How Does It Work?
Pectopexy was first described in 2012 and has gained rapid acceptance in minimally invasive gynaecological surgery as a technically sound, reproducible alternative to sacrocolpopexy. It targets the same problem — apical prolapse — through a different anatomical anchor point.
In pectopexy, the uterus (in a hysteropexy variant) or the vaginal vault (after hysterectomy) is attached via a short mesh band to the iliopectineal ligament, also called the pectineal ligament or Cooper’s ligament. This structure runs along the superior pubic ramus on the inner surface of the pelvis on both sides. It is robust, accessible laparoscopically, and importantly — it sits away from the major presacral vessels that make sacral fixation the riskiest part of sacrocolpopexy.
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Why the Iliopectineal Ligament?
- Strong, consistent, and easily identifiable anatomical landmark on both sides of the pelvis
- No major vessels or nerves immediately adjacent — reduces haemorrhage risk significantly
- Bilateral fixation gives symmetric lateral support — reduces the risk of de novo lateral deviation
- Shorter mesh strip needed compared to sacrocolpopexy — less foreign material in the body
- Avoids the presacral dissection that carries the 1–3% risk of life-threatening haemorrhage in sacrocolpopexy
Pectopexy vs Sacrocolpopexy — The Key Differences
Most patients who have been told about pectopexy have also heard of sacrocolpopexy. Here is how the two procedures compare:
| Factor | Pectopexy | Sacrocolpopexy / Sacrohysteropexy |
|---|---|---|
| Anchor Point | Iliopectineal (Cooper's) ligament attached to the pelvic sidewall. | Sacral promontory at the base of the spine. |
| Presacral Dissection | Not required. | Required; considered the highest-risk step of the procedure. |
| Major Haemorrhage Risk | Very low. | Approximately 1–3% risk of presacral vessel injury. |
| Mesh Length | Short bilateral mesh strips. | Longer mesh attached to the sacrum. |
| Operating Time | Usually shorter (60–90 minutes). | Usually longer (90–150 minutes). |
| Anatomical Restoration | Provides balanced bilateral pelvic support. | Creates a posterior midline pull. |
| Apical Prolapse Correction | Excellent results comparable to sacrocolpopexy. | Excellent; long-established gold standard. |
| Evidence Base | Growing evidence with multiple randomized clinical trials. | More than 20 years of long-term clinical evidence. |
| Available with Dr. Gurram | ✔ Yes – Available at Baner & Thergaon. | ✔ Yes – Performed when clinically indicated. |
Two Variants — Pectopexy With Uterus or After Hysterectomy
Laparoscopic Pectopexy (Uterus-Preserving / Hysteropexy Variant)
The uterus is retained and suspended bilaterally to the iliopectineal ligament using mesh. This is the preferred option for women who do not want a hysterectomy. The uterus acts as a natural anchor point in the middle and the mesh fixes it laterally and superiorly. Results are durable and the uterus is fully preserved.
Women from Baner, Thergaon, Wakad, Pimpri, and Chinchwad who present to Dr. Gurram with symptomatic prolapse and a healthy uterus are frequently offered this approach.
Laparoscopic Pectopexy (Vault Suspension After Hysterectomy)
For women who have already had a hysterectomy and subsequently develop vaginal vault prolapse, pectopexy suspends the vault to the iliopectineal ligament on both sides. This is an excellent alternative to sacrocolpopexy for post-hysterectomy vault prolapse and avoids the need for presacral dissection in patients who may already have pelvic adhesions from prior surgery.
The Surgery — What Happens at Dr. Gurram's Clinic
Pre-operative Assessment
Before surgery, Dr. Gurram performs a systematic pelvic examination to confirm the grade and compartments of prolapse. A pelvic ultrasound is standard. If urinary symptoms are significant, urodynamic studies assess bladder function before the operation. Blood tests and anaesthetic fitness are completed. Patients at both the Baner and Thergaon locations go through the same pre-operative protocol.
In the Operating Theatre
General anaesthesia. Three to four incisions under 1 cm on the lower abdomen. The laparoscope gives a clear, magnified view of the pelvic anatomy. Dr. Gurram identifies the iliopectineal ligament on each side — accessible without entering the presacral space. A short mesh strip is fixed to the ligament bilaterally, then attached to the uterus (or vaginal vault), lifting and re-suspending the apical compartment to its correct anatomical position.
If a simultaneous anterior repair (for bladder prolapse) or posterior repair (for bowel prolapse) is needed, this is done in the same sitting. Operating time: typically 60 to 100 minutes.
After Surgery
Hospital stay is usually 1 to 2 days. A urinary catheter is removed within 24 hours. Patients from Baner, Thergaon, Pimpri, Chinchwad, and surrounding PCMC areas typically return home the following morning and are back to light activity within a week. Full recovery takes 4 to 6 weeks.
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Type of Tubal Ligation Affect the Result?
| Time | Expected | Activity |
|---|---|---|
| Day 1 (Hospital) | Mild discomfort; catheter removed by morning; light diet started. | Ward walking with assistance; adequate rest. |
| Day 2 (Discharge) | Feeling comfortable; mild port-site soreness. | Slow walking at home. |
| Week 1 | Low energy; pelvic tenderness gradually settling. | Light indoor activities; avoid lifting over 2 kg and driving. |
| Week 2 | Soreness mostly resolved; pain medication usually no longer needed. | Short outdoor walks; desk work from home if comfortable. |
| Week 3–4 | Near-normal energy and improved comfort. | Return to desk work; avoid strenuous exercise. |
| Week 5–6 | Full recovery; follow-up consultation with Dr. Gurram. | Resume normal daily activities; continue pelvic floor exercises. |
| 3 Months | Mesh fully integrated; pelvic support remains stable. | Unrestricted activities unless advised otherwise. |
Key Post-op Rules
- No lifting more than 2–3 kg for 6 weeks — the single most important rule
- No sexual intercourse for 6 weeks
- Pelvic floor (Kegel) exercises from Week 2 — continue lifelong
- Avoid straining at stool — increase fibre and fluids from Day 1 to prevent constipation
- Avoid prolonged standing in the first 2 weeks
- Contact the clinic immediately if: fever, heavy bleeding, inability to urinate, or severe worsening pain
Who Is a Candidate for Pectopexy in Pune?
- Women with symptomatic apical prolapse (uterine prolapse or vaginal vault prolapse) — Grade 2 or above
- Women who want to preserve their uterus — pectopexy can be done as a hysteropexy variant
- Women with post-hysterectomy vault prolapse — pectopexy is an excellent vault suspension option
- Women in whom sacrocolpopexy carries elevated risk — prior sacral surgery, obesity, dense pelvic adhesions
- Women with combined apical and anterior/posterior prolapse — all repaired in one procedure
- Women in Baner, Thergaon, Pimpri, Chinchwad, Wakad, Hinjewadi and across PCMC within reach of Dr. Gurram's two clinic locations
Frequently Asked Questions
Pectopexy is a laparoscopic surgery to fix pelvic organ prolapse by suspending the uterus or vaginal vault to the iliopectineal (Cooper's) ligament on the inner pelvic bone using a short mesh strip. It avoids dissection near the sacral blood vessels, making it safer than sacrocolpopexy with equivalent results.
Pectopexy gives equivalent prolapse correction with a lower haemorrhage risk, shorter operating time, and no presacral dissection. For most patients with apical prolapse, it is now the preferred approach. Dr. Gurram discusses which is right for each patient individually.
Typically 60 to 100 minutes under general anaesthesia. Combined procedures with anterior or posterior repair take slightly longer.
Dr. Ammbalal Gurram performs pectopexy at Manipal Hospital Baner and Ashwinii Nursing Home Thergaon (PCMC). Call 086007 11131.
Most patients recover fully in 4 to 6 weeks. Hospital stay is 1 to 2 days. Light activity resumes in 1 to 2 weeks.
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