The Pre & Post Operative Processes of the Anterior Posterior Vaginal Repair
2) About the Anterior Posterior Vaginal Repair Surgery
- During the Anterior Posterior Vaginal Repair Surgery,
while the patient is sleeping, Dr. Vitasna will open and remove the excess anterior vaginal wall tissues that are bulging into the vagina. Thus, the anterior vaginal wall tissues are separated forming an inverted V shape incision with its narrow side near the vaginal opening and the wide one near the cervix as Figure 3.
Figure 3: Anterior Vaginal Wall Repair
- Afterwards, Dr. Vitasna will suture the wound edges or two sides of the V shape incision with absorbable suture, beginning from the vaginal opening side. The suturing is done along the entire length of the anterior vaginal wall. The suturing is done alternatively with 2 or 3 layers.
- Following this, Dr. Vitasna will remove the excess posterior vaginal wall tissues bulging into the vagina. Thus, the posterior vaginal wall tissues are separated forming an inverted V shape incision with its wide side near the vaginal opening and the narrow one near the cervix as Figure 4.
- Therefore, the Pelvic Organ Prolapse, or the Vaginal Relaxation, will be corrected, and the vaginal wall will become more strengthened. Vaginal packing is done for 24 hours after the operation to control and stop the bleeding, and a urinary catheter will be inserted for 3-5 days after the surgery.
Figure 4: Posterior Vaginal Wall Repair
3) After the Anterior Posterior Vaginal Repair Surgery
- After the surgery, the patient is assured to be well taken care of in a safe and professional way by our highly trained and educated staff. The patient will be wheeled to the recovery room. Expect to be conscious a minute or two after the surgery ends. However, it is very unlikely the patient will remember anything, until she is cleared to go back to her room in the Inpatient Building.
- The patient will be monitored in our recovery room for 1-2 hours. When she is conscious with normal vital sign, the anesthesiologist will allow her to be monitored in the Inpatient Building. Nausea and vomiting may be experienced, as a side effect of the General Anesthesia, which is noted to be relieved as soon as its effect wears off. It is advised that the patient stay in bed until she feels better.
- In the Inpatient Building, the patient will be given an antibiotic to prevent post-operative infection, a laxative drug to prevent constipation, an anti-inflammatory drug and an acetaminophen to lessen the wound pain.
- Pain levels depend on an individual’s pain tolerance. Pain varies from person to person. If the pain cannot be relieved from the acetaminophen, the nurse will administer an analgesic by injection as ordered by Dr. Vitasna.
- In our hospital, the clients can choose to pay for a “pain-free program”, where the patient will be given a machine that she can control, and enables her to give herself appropriate levels of pain relief.
- Urinary frequency or difficulty in urination may be noted due to the tension of the vaginal opening muscle. As a result, a urinary catheter may be inserted to avoid the retention of urine, which may be the cause of cystitis, especially during the first 3-5 days after the surgery. Then, when the tension disappears, the patient will be able to urinate normally.
- In a few days after the surgery, the patient may experience an urge to pass stool (straining), and a sense of incomplete emptying, even after the enema before the surgery. This is caused by the sutured posterior vaginal wall between rectum and vagina. Taking a rest is recommended to reduce this symptom. Laxatives will be given to prevent constipation.
- Within the first 3-5 days after the Anterior Posterior Vaginal Repair, the patient will be able to have movement and walk around, and the patient should not take a shower, which may potentially cause infection (perhaps rub the body dry). Cleaning the surgical wound at the perineum area after fecal excretion may be done using water and toweling gently.
After 3-5 days of the surgery, Dr. Vitasna will allow the patient to go home after the following issues are checked:
- No abnormal bleeding occurs from the surgical wounds.
- The patient can urinate after the urinary catheter is removed.
- The patient is provided details regarding post operative care instructions.
Read more about the related issues of the A-P Vaginal Repair
4) Post Operative Care Instructions at home after the Anterior Posterior Vaginal Repair
- At home, the patient must take an antibiotic, an anti-inflammatory drug, a laxative, and an acetaminophen. The antibiotic should be completely consumed according to schedule.
- After 3-5 days of the surgery, the patient is allowed to take a shower. The patient should clean the surgical wound at the perineum area with soap daily, when she is taking a shower in the morning or before bedtime. Do not put anything to clean inside of the vagina.
- Within the first 5-7 days after the surgery, the patient should take a rest (refrain from work) and be still to enable the wound to heal faster, and have little movement as possible to avoid wound disruption.
- The patient may experience light reddish bleeding out of the vagina in around 1-2 weeks after the surgery. A slim sanitary napkin should be used to monitor the post-operative bleeding. In case of a lot of bleeding or blood clot, swollen reddish wound and high fever, please contact the Hospital for suggestions or come to see Dr. Vitasna for the surgical wound examination.
- Within the first 2 weeks after the surgery, cleaning the surgical wound at the perineum area after urinary excretion may be done with sanitary wipes, and after fecal excretion done using water and toweling gently. The patient should try to avoid moisture around the surgical wound to keep the area day to let it heal faster.
- After the surgery, the patient may have all kinds of food, with the exceptions of alcoholic drinks and smoking for about 2 weeks.
- The material used for the surgery is the sutures which dissolve slowly (within 6-8 weeks). However, for some women, the sutures take longer than 6-8 weeks to completely dissolve, consequently causing irritation. For women who experience itching caused by the dissolving sutures and the process of healing, Dr. Vitasna may prescribe antihistamine to control the itching.
- The patient may have abnormal vaginal discharge, green-yellowish discharge after the surgery, because the vagina is full of secretion fluid and various kinds of bacteria. This can cause reaction to the surgical wound and sutures. Complete absorption of the sutures will usually occur within 6-8 weeks. Green-yellowish discharge may also persist during this time.
- And you may experience itching or curd like discharge as a result of vaginal fungal infection, possibly following taking antibiotic to avoid post-operative infection. In case of smelly vaginal discharge or vaginal fungal infection, the patient has to take additional medications.
5) Recovery period after the Anterior Posterior Vaginal Repair
- Recovery varies, the patient may return to work after 5-7 days of the surgery. Dr. Vitasna will have a post-operative appointment with the patient within 1-2 weeks after the surgery, the patient should follow Dr. Vitasna’s appointment for follow up examination or treatment.
- Within the first 2 weeks after the surgery, tissues are beginning to produce and form new blood capillaries, and the surgical wound is expected to start healing. The patient may start her daily activities gradually.
- After the first 2 weeks to 4 weeks after the surgery, the surgical wound is expected to heal appropriately, the patient may start her usual activities gradually. Strenuous physical activities should be limited.
- After 4 weeks of the surgery, the patient may do her usual activities. Relaxing exercises and lifting light weights are permitted. However, the patient should refrain from running, soaking in bathtub, swimming, heavy lifting, cycling, heavy lifting, other heavy activities, and sexual intercourse for at least 6-8 weeks after the surgery.
If you decide to have a consultation with Dr. Vitasna, please call or email a member of staff to make an appointment date for the surgery.
Anterior Posterior Vaginal Repair 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.