AAVIS Information Sheets

POSTERIOR IVS

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 weighed 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

Posterior IVS is performed to correct an enterocoele, which forms after
hysterectomy. The ligaments are weakened and a hernia forms at the site where
the uterus was removed, pushed down by the bowel above and it protrudes through
the vagina. To repair this defect, a tape is passed from near the coccyx bone,
up past the rectum to the site of the enterocoele, and then passed down through
the other side. This tape is attached to the remains of the weakened pelvic
ligaments. A fibrous reaction occurs around the tape, to strengthen and
replace the weakened ligament.

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 in the post operative recovery 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 administered. The
nursing staff will measure the volume of urine passes each time to make sure
that there is no retention of urine. In this case, a small 'in-out' catheter
will be passes to empty 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.

5. DISCHARGE HOME

The operation was designed for 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 limited work within 14 days. However, in most
patients, recovery may take longer.

Please remember to be sensible. Most operations that fail do so because
sutures tear out of the vagina or the tape is dislodged due to excessive straining and lifting. Vaginal intercourse should be avoided for 6 weeks. Some sutures take 8 - 12 weeks to
dissolve, and if necessary, can be removed earlier. 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 can be made one week after the operation if there is a problem. There is a routine followup at six weeks. There may be some vaginal bleeding for the first few days after the operation.

7. RESULTS OF THE OPERATION

The results of any operation cannot be guaranteed, and it is possible for the
condition to recur at a later date. However, unlike other vaginal repair
operations, there should be a cure of the prolapse without shortening the
vagina or making it too tight and thus causing pain with intercourse.

8. COMPLICATIONS

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

The complications that can occur include, but are not limited to the following:

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

b) Haemorrhage - this is extremely rare. Secondary haemorrhage is more likely to occur if activity is excessive in the first 4 weeks.

c) Injury to Rectum - if the instrument inserting the tape passed through
the rectum this could lead to infection, but as it is only a puncture wound,
withdrawing the instrument should not cause any problems.

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

e) Rejection of the Tape- this complication appears to have been completely eliminated by
the change to a polypropylene tape. Tape complications are usually managed easily by removal of the affected piece of tape.

f) Injury to Bowel- if the bowel is well down in the enterocoele sac,
there is a small risk that it could be caught in the sutures.