Anterior Posterior Vaginal Repair with Mesh 1
In Pelvic Organ Prolapse, the prolapse may occur alone, like only uterine prolapse, or more commonly in combination with any of the other prolapses (e.g. with bladder prolapse and/or rectum prolapse), and it may not always be apparent, what has to be repaired until the patient is on the operating table.
- The cause of pelvic organ prolapse, is a weakening of the pelvic support structures. The pelvic organs include the vagina, uterus, bladder, bowel, and rectum. These organs are kept in place with the help of 3 support systems; muscles, ligament sheets, and fascia. If these supports become damaged or weakened, one or more of the pelvic organs may begin to sag. These are referred to as pelvic support defects.
- In rare cases where Pelvic Prolapse progresses into more advance phases, a mass can actually be seen protruding from the vaginal entrance. This is known as Severe Pelvic Organ Prolapse (POP-Q grade 3 or POP-Q grade 4 in Figure 2 and 3).
- Mesh and other synthetic materials are helpful when prolapse occurs or the tissues are poor, and traditional surgery such as Anterior Posterior Vaginal Repair is unlikely to provide a long-term cure, especially in severe pelvic organ prolapse.
- The benefits of the Anterior Posterior Vaginal Repair with Mesh must be weighed against the risks. A full consideration of the alternative treatments should be made, including the consequences of no treatment. Make sure that you understand the proposed surgery and the possible complications, and please ask any questions if you are unsure.
Figure 1: The Gynecare ® Mesh
General Notes & Precautions
1) Important points to consider about Anterior Posterior Vaginal Repair with Mesh
- The Anterior Posterior Vaginal Repair with Mesh is the surgery using the mesh and other synthetic materials to support the vaginal wall and to recreate the strength of the tissue protruding into the anterior and posterior vaginal wall, as well as to revive the prolapse of the bladder and rectum.
- This is performed by a skilled physician, fixing the vaginal wall by substituting the sagging tissues with mesh, thus anchoring the Pelvic Organ Prolapse and strengthening the vaginal wall. Studies have shown that mesh is very effective with low rates of complication, if used correctly with the right patient. However, complications are known to occur with any surgical procedure no matter who is doing them or what material (if any) is used. It is probably more important to have a surgeon that is skilled, in not only the surgical procedure, but also in recognizing the potential complications and treating them adequately if they occur.
- In our center, Anterior Posterior Vaginal Repair with Mesh is recommended only for the older patients (not in sexually active women). The patient should obtain the approval of her spouse before surgery as marriage problems and misunderstanding may occur due to abstinence from sexual intercourse after the surgery. In addition, the Anterior Posterior Vaginal Repair with Mesh is not allowed for women with immunodeficiency.
- The Anterior Posterior Vaginal Repair with Mesh has limitations and cannot absolutely ensure satisfactory results, as there are so many factors affecting the surgery’s success. In case of unexpected surgical results or complications, corrective surgery is an option and will be discussed between the patient and the surgeon. If correction surgery is needed due to the complication of the surgery, all expenses for services and treatment will no longer be charged to the patient. However, if the unsatisfactory results occur due to the complication from the patient’s non-compliance with the doctor’s orders, the patient will be charged accordingly.
- The Anterior Posterior Vaginal Repair with Mesh is one of the most complex and meticulous cosmetic surgeries performed today. It requires extensive experience, precision, and accuracy to create the optimal results the patient desires and deserves. Many surgeons have little to no experience with this type of advanced urogynecology surgery. The patient should research and be conscious of the surgeon’s educational background, training, and practical experience.
- The patient should take a rest (refrain from any physical activities), and be still for at least 3-5 days after the Anterior Posterior Vaginal Repair with Mesh to enable the wound to heal faster. The patient may return to work within 5 to 7 days after the surgery, she should have little movement as possible to avoid wound disruption for 1-2 weeks after the surgery. The patient should refrain from some types of exercise affecting pelvic muscle movement for 6-8 weeks after the surgery.
- The Anterior Posterior Vaginal Repair with Mesh is performed in our operating room for approximately 1-2 hours under General Anesthesia. The patient has to refrain from drinking water or food for at least 6 hours prior to the surgery in order to decrease the risk of aspirating gastric contents during or after surgery. This complication is very serious, and the patient needs to strictly follow our recommendations.
Figure 2: POP-Q grade 3