Vaginal Paravaginal Repair


Aim: The objective of this surgery is to reattach detached lateral vaginal fascia to its normal point of insertion on the lateral side wall. This firm area of attachment is termed the white line or arcus tendineus fascia pelvis.

Indication

The repair of anterior wall prolapse due to defects of the lateral supporting tissues

Procedure

The procedure can be performed under regional or general anaethesia.

Routine anterior repair

The sharp dissection of the vagina from the bladder fascia continues laterally till the pelvic side wall can be identified.

Permanent or delayed absorbable sutures are placed from the lateral vagina to the firm pelvic side wall tissue (white line or arcus tendineous fascia pelvis). Three to four sutures are placed on each side.

A routine anterior repair with midline plication of the fascia, trimming of excess vaginal skin as required and closure of the vaginal skin.

Surgery will be covered with antibiotics to decrease the risk of infection and blood thinning agents will be used to decrease the risk of clots forming in the postoperative phase. 

Complications

  • 5-10% failure rate
  • 1-5% develop stress urinary leakage that was not present before the surgery.
  • 1-5% has difficulty passing urine necessitating the need for catheters to be used for a prolonged period of time.
  • Inadvertent damage to the urethra or bladder occurs rarely and is usually repaired during the surgery. If the damage is not repaired at the time of the surgery a fistula between the bladder and vagina can occur (1-2/1000 cases)
  • 5% develop a urinary tract infection postoperatively.
  • Clots can form in the legs or lungs <1%
  • Confidence and comfort during sexual activity from repair of prolapse or urinary leakage is likely to have a positive effect on sexual function.

In hospital and recovery

You can expect to stay in hospital between 3-6 days. The vaginal pack, if used is removed on the first day and the bladder catheter after the first few days. In the early postoperative period you should avoid situations where excessive pressure is placed on the repair ie lifting, straining, coughing and constipation. Maximal fibrosis around the repair occurs at 3 months and care needs to be taken during this time. If you develop urinary burning, frequency or urgency you should see your local doctor. You will see Dr Maher at 6 weeks for a review and sexual activity can usually be safely resumed at this time. You can return to work at approximately 4-6 weeks depending on the amount of strain that will be placed on the repair at your work and on how you feel.