aavis patient information

 1.    INTRODUCTION

 The decision to undertake surgery is an important one.  It must be realized and accepted that complications may occur.  Although major complications are not common, they may be disabling and even life threatening, and may require further surgery to correct.  This can lead to prolonged recovery time and even permanent disability and loss of function.

 The benefits of the operation must be weighted against the risks.  A full consideration of alternative treatments should be made, including the consequences of no treatment.

 It is your responsibility to make sure that you understand the proposed surgery and to ask any questions if you are unsure.

 2.  PROCEDURE

 Vaginal repair is performed for prolapse, which is a situation where the ligaments supporting the vagina and uterus have given way and are stretched and loose due to childbirth and age.  Apart from prolapse of the uterus, there are three main types of prolapse and repair.

 a)      Bladder - cystocoele: anterior repair.

b)      Rectum - rectocoele: posterior repair.

c)      Bowel-enterocoele: repair and posterior vaginal sling.

 These may occur alone, or more commonly, in combination, and it may not always be apparent what has to be repaired until the patient is on the operating table. Mesh and other synthetic materials are  helpful when prolapse recurs or the tissues are poor and traditional surgery is unlikely to provide a longterm cure.

 The operation involves replacement of tissues with mesh to recreate strength. The skin is closed and the mesh is unable to be seen or felt. A vaginal packs and catheter is used to encourage the skin to stick to the mesh without any bleeding building up inside the repair.

 3.  ADMISSION TO HOSPITAL

 This normally occurs the morning of the operation.  You should have nothing to eat, drink or smoke from midnight the night before.  If the operation is to be in the afternoon, you can have a light breakfast before 6.00am .  e.g. toast, tea or coffee.  If you develop a cough, cold or fever before the operation, it may need to be postponed.

 The appropriate anaesthesia will be decided by the anaesthetist and should be discussed with him or her.  The anaesthetist will arrange the appropriate premedication if required.  If there are major medical problems, the operation can be performed under local anaesthesia.  

If you are currently taking Aspirin, Indocid, Naprosyn or other anti-inflammatory drugs, these should be discontinued ten days before the operation. Please bring a packet of sanitary pads with you to the hospital with your own night attire and toiletries.

 4. RECOVERY

 You will wake up in the post operative room within the theatre complex.  You may have an oxygen mask fitted comfortably over your mouth and nose.  There will be an intravenous 'drip' (IV) needle in your arm.  Analgesic medication will be prescribed to prevent any post operative pain.  The pain is  minimised as local anaesthetic is injected into the operative area.

 There may be some nausea and vomiting, although medication to counteract this is routinely given during the operation.  If you continue to feel nauseated, notify the nursing staff so that further medication may be administered.  The nursing staff will measure the volume of urine passed. A catheter is left in the bladder with a vaginal pack for 48 hours after the operation. Most patients go home on the third or fourth day after surgery.  

The amount of vaginal bleeding will be checked on a regular basis. Once fluids are tolerated, the intravenous 'drip' will be removed.  You should not drive yourself home.

 5.   DISCHARGE HOME

 These operations can be major procedures performed through minimally invasive techniques. You may not be able to drive your car, cook, shop, look after your children for at least four weeks. Full recovery will take at least three months.

 Please remember to be sensible and follow your specific instructions.  Most operations that fail do so because sutures tear out of the vagina due to excessive straining and lifting.  Vaginal intercourse should be avoided for 6 weeks.  Some sutures take 8-12 weeks to dissolve, and may make intercourse uncomfortable until dissolved.

 Avoid tampons during this time and prevent constipation with orange juice, bran and other fibre products. Use medication as prescribed for the first 3 months.

 It is important to exercise extreme care when getting in or out of a car or getting up from a chair.  In particular, the knees should be kept together as much as possible during activity, especially lifting and squatting.

 6.   FOLLOW UP  

An initial appointment should be made 2-4weeks after the operation, or earlier if there is a problem.  There is a further follow-up at 2-3 months.  There may be some vaginal bleeding in the first few days after the operation.  You should be able to pass urine normally.  For the first few days, you may experience some urgency i.e. a desire to pass urine frequently.  This could be a result of the catheter used at the operation or due to swelling around the sutures.

 7.  RESULTS OF THE OPERATION

 The results of any operation cannot be guaranteed, but if you are careful during the initial healing phase, the results are normally excellent. 

 8.   COMPLICATIONS

 Complications are rare, but it must be understood and accepted that these can occur.

a)   Infection - there may be a simple infection of the urine or pelvis requiring antibiotics alone.  However, a pelvic abscess could develop requiring

drainage and removal of the mesh.

b) Mesh rejection or erosion occurs in 2-3% of patients and may also require part or all of the mesh or tape to be removed.

b)  Haemorrhage -  reoperation to control bleeding is rare, and is usually treated conservatively.

c)  Retention of Urine - this is rare, but if it did occur, a catheter would need to be inserted.

d)   Injury to Bladder - during dissection, an incision may be made in the bladder.  This would be repaired and a catheter inserted.

e)   Injury to Ureter -  the ureter which brings urine from the kidney to the bladder may be kinked or tied.  This could cause pain in the kidney and

possible fistula formation, and would require an abdominal operation to correct and reimplant it into the bladder.

f)   Injury to Bowel - if there is an enterocoele, the bowel could be caught by a suture, and this would require an abdominal incision to correct.

g)  Deep Venous Thrombosis - a possible complication of any surgery, but much less likely with this type of operation where you are mobilized almost immediately.