Vaginal Repair 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.

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 sacropexy.

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.

The uterus is not usually removed unless there are also specific problems of the uterus itself. If future pregnancy is desired, then a caesarean section is required.

The operation involves careful dissection and strengthening of the ligaments, avoiding the areas most likely to cause pain. Local anaesthesia is injected at the time of surgery, and post operative pain is minimal. In the vast majority of cases vaginal packs and catheters are not required.

In a Vaginal Bridge Repair epithelium is recycled as fascia and used to strengthen the underlying tissues, similar to a mesh or biological implant. Traditional repair surgery involves excision of epithelium and plication of the muscle and fascia to create scarring which reinforces the tissues.

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 may be an intravenous 'drip' (IV) needle in your arm. Analgesic medication will be prescribed to prevent any post operative pain. The pain is usually minimal 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 each time to make sure that there is no retention of urine. In this case, a small 'in-out' catheter will be passed to empty the bladder. This is not left in the bladder.

The amount of vaginal bleeding will be checked on a regular basis. Once fluids are tolerated, the intravenous 'drip' will be removed. You will normally be discharged home the afternoon of the operation or the next morning. A longer hospital stay can be arranged according to personal circumstances. You should not drive yourself home.

5. DISCHARGE HOME

These operations were designed to enable patients to return to work and normal activities as soon as possible. i.e. you can usually drive your car, cook,

shop, look after your children within a day and return to work within 7 days. However, in some patients, recovery may take longer.

Please remember to be sensible. 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.

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 one week after the operation, or earlier if there is a problem. There is a further follow-up at 6 weeks. 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, the results are normally excellent. However, unlike other types of vaginal repair operations, there should be cure of the prolapse with minimal discomfort and a rapid return to normal activities because vaginal skin is not excised. If there is no improvement it is due to the sutures tearing out of damaged tissues, but because the vagina is not excised the operation can be easily adjusted later to improve the results.

 

8. COMPLICATIONS

Complications are rare, but it must be understood and accepted that these can occur. The complications that can occur include, but are not limited to:

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

b) Haemorrhage - this is extremely rare, but is watched post-operatively.

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.

It must be emphasized that complications are extremely rare with this type of surgery, and most of the above have not yet been encountered.

 

 

 

 

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Note: This information is provided by AAVIS as general information for patients undergoing surgery. It does not replace information provided by your doctor nor should it be seen as specific instructions for any operation you may undertake. AAVIS recommends that you discuss any issues that may arise from this information with your own doctor and if necessary seek a second opinion.