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.
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 Gynecare ® Mesh
General Notes & Precautions
1) Important points to consider about Anterior Posterior Vaginal Repair with Mesh
The benefits of the surgery 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.
This surgery 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, this surgery 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 problem, 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.
This surgery 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 patient should take a rest (refrain from any physical activities), and be still for at least 5-7 days after the surgery to enable the wound to heal faster. The patient may return to work after 5 to 7 days of 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 at least 6-8 weeks after the surgery.
This surgery 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.
2) Before the Anterior Posterior Vaginal Repair with Mesh
The patient will be invited to a pre-operative consultation room, where she will be evaluated for surgery. The patient will be received by a member of the nursing staff in our Center, who will make inquiries regarding her previous medical history as well as arrange for the vital signs such as temperature, respiration, blood pressure, and pulse. In case of existing diseases or drug allergies, please inform the medical staff before the consultation. The patient should take with her any pills or treatment medications, she is currently taking.
The patient can possibly have the surgery done on the day of her consultation depending on the availability of Dr. Vitasna’s schedule. Otherwise, the patient may book for a possible surgery on the day of her consultation. This the patient may do through online pre-consultation and arrangement. It is best to undergo the surgery after her period. It is not advisable to do the surgery just before the period starts or during the period.
A staff nurse will usher the patient to a treatment room, where Dr. Vitasna will investigate her health history, and conduct both a general check-up and internal check-up. In case the patient has vaginal fungal or bacterial infection, she should completely treat it before the surgery to avoid wound infection after the surgery.
After the examination and assessment, the patient will discuss with Dr. Vitasna about her expectations and concerns. Dr. Vitasna will then explain to the patient about the methods (or techniques), processes of the surgery, some potential post-operative risks and complications prior to decision-making. The patient may also be asked if she has any allergies or any condition that wouldn’t make her a good candidate for the surgery as well as other additional inquiries.
After the patient has chosen the best alternative for her case, prices and quotes will be written down with her. —This ends her consultation.
3) Cost of the Anterior Posterior Vaginal Repair with Mesh
The cost of the surgery will include professional fees for the anesthesiologist and the surgeon, all the instruments, the home medications, and the medicine used in the surgery as well. However, fees for laboratory work for other existing diseases that the patient may have, and the professional fees for the anesthesiologist and the surgeon for corrective surgery are not included in the package.
4) Read more about : The Pre Operative Processes on the day of the Surgery
The Processes of the Anterior Posterior Vaginal Repair with Mesh
1) About the Anterior Posterior Vaginal Repair with Mesh Surgery
During surgery, while the patient is sleeping, Dr. Vitasna will open and remove some parts of excessive anterior vaginal wall tissues (which bulge into the vagina), and supports the saggy tissues with synthetic mesh to recreate the strength of the anterior vaginal wall. Following this Dr. Vitasna will tighten and suture the wound edges with slow absorbing suture. The suturing is done along the entire length of the anterior vaginal wall. The suturing is done alternatively with 2 or 3 layers, so the vaginal mucosa is closed and the mesh is unable to be seen and felt.
Then Dr. Vitasna will perform the same surgical procedure at the posterior vaginal wall. Therefore, the Pelvic Organ Prolapse will recover and the vagina wall will become more strengthened.
After the surgery, the patient’s vagina needs vaginal packing for 24 hours to encourage the vaginal mucosa to stick to the mesh and prevent any bleeding inside the surgical wound, and the patient needs to be catheterized for 3-5 days after the surgery.
Mesh placement anterior prolapse
Mesh placement posterior prolapse
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 desire and deserve. 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.