Anterior Posterior Vaginal Repair for Pelvic Organ Prolapse 1

blue-shutterstock_94733821When 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.

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.

General Notes & Precautions

1) Important points to consider about the Anterior Posterior Vaginal Repair

  • bullet_tickThe Anterior Posterior Vaginal Repair 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.
  • bullet_tick The Anterior Posterior Vaginal Repair 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.
  • bullet_tickThe Anterior Posterior Vaginal Repair 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.
  • bullet_tickThe Anterior Posterior Vaginal Repair 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.
  • bullet_tick After the Anterior Posterior Vaginal Repair, 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.
  • bullet_tickThe Anterior Posterior Vaginal Repair 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

  • bullet_tickIn this regard, the Anterior Posterior Vaginal Repair Vaginal Repair 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

  • bullet_tickPrior to 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.
  • bullet_tickThe patient can possibly have the Anterior Posterior Vaginal Repair 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.
  • bullet_tickA 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.
  • bullet_tickAfter 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 Anterior Posterior Vaginal Repair, 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.
  • bullet_tickAfter the patient has chosen the best alternative for her case, prices and quotes will be written down with her. —This ends her consultation.

 

 anterior prolapse 

Figure 1: Anterior Vaginal Wall Prolapse

 

posterior prolapse

Figure 2: Posterior Vaginal Wall Prolapse

 

4) Cost of the Anterior Posterior Vaginal Repair

  • bullet_tickThe cost of the Anterior Posterior Vaginal Repair 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.

Because of technological advances, gynecology procedures involving 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.

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