AAVIS Information Sheets

VAGINAL REPAIR

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 not treatment.

It is your responsibility to make sure that you understand the proposed surgery
and to ask any questions if your 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 enterocoele, associated with Posterior IVS.

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, caesarean section is
recommended.

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.

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 care, 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 to 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 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 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.