Anterior Posterior Vaginal Repair is a surgery for the loss of optimal structural integrity of the anterior and the posterior walls of the vagina, resulting in different organs around the vaginal walls pushing and forming a bulge into the vagina or the vaginal opening.
When the muscles and ligaments supporting a woman’s pelvic organs weaken, the pelvic organs can slip out of place (prolapse). Pelvic organ prolapse can worsen over time and you may need surgery to fix it.
This is due to the fact that the muscles of the perineum, the group of supporting muscles located below the lower part of the vaginal opening become thin and the mid-line begins to deviate, thus leading to a weakened, poorly supportive, thinned out perineal body.
The cause of pelvic wall relaxation is a weakening of the pelvic support structures (see the Figure 1 and Figure 2). The pelvic organs include the vagina, uterus, bladder, bowel, and rectum. These organs are kept in place with the help of 3 support systems from muscles, ligament sheets, and fascia.
During the course of childbirth, as the baby journeys through the birth canal, these supports become damaged and tend to become weakened. This weakening increasingly worsens and further on down the line, may cause the pelvic organs to shift from their normal positions.
General Notes & Precautions
1) Important points to consider about the Anterior Posterior Vaginal Repair
- This surgery is a surgical procedure designed for the removal of excess anterior and posterior vaginal wall tissues bulging into the vagina. Consequently, the Pelvic Organ Prolapse or Vaginal Relaxation will be corrected, and the vagina will become more tightened.
- This surgery is not recommended unless the patient has any discussion with her spouse because this may lead to problems, and misunderstandings caused by refraining from sexual intercourse for quite a long time.
- This surgery is not allowed for women with immunodeficiency. In addition, the patient must not become pregnant, nor plan to become pregnant within 3 months after the surgery. This is a suggestion, despite no research about their being a disadvantage to the pregnancy and the newborn.
- This surgery has limitations and cannot absolutely ensure satisfactory results, because 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, she will be charged accordingly.
- After the surgery, 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 5-7 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 and sexual intercourse 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 the surgery. This complication is very serious, and the patient needs to strictly follow our recommendations.
2) Stress Urinary Incontinence and the Anterior Posterior Vaginal Repair
- In this regard, this surgery is not a permanent solution to Stress Urinary Incontinence, which may be experienced by the patient within 5 years after the surgery.
3) Before the Anterior Posterior Vaginal Repair
- 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.
Figure 1: Anterior Vaginal Wall Prolapse
Figure 2: Posterior Vaginal Wall Prolapse
4) Cost of the Anterior Posterior Vaginal Repair
- The cost of the surgery will include; professional fees for the anesthesiologist and the surgeon, all the instruments, medicines used during the surgery, and the home medications 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.
5) Read more about : The Pre Operative Processes on the day of the Surgery
The Processes of the Anterior Posterior Vaginal Repair
1) About 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
Because of technological advances, the use of laser have been utilized in anterior-posterior vaginal repair. Advantages of laser over old conventional scalpel procedure include: less blood loss, less risk of vessel and tissue damage, precise and accurate surgical wound control, quicker recovery time, and better overall results.