ANTERIOR AND/OR POSTERIOR VAGINAL REPAIR (COLPORRHAPHY)


Indications

Anterior repair: treatment for prolapse of bladder (bladder bulges forward into the vagina; cystocele) or urethra.

Posterior repair: correction of bowel prolapse (rectum bulges forward into the vagina; rectocele) Vault repair: treat prolapse of upper vagina

Depending on the side of the defect, the repair can either be anterior, posterior, vault or total. The repair is achieved by the placement of permanent mesh that may result in a stronger repair.

Surgical Technique

The procedure can be performed under regional or general anaesthesia.

Anterior vaginal repair:

  • Midline incision to the vagina overlying the bladder and urethra.
  • Dissection in a plane directly below the vagina and lateral of the bladder allows the damaged fascia supporting the bladder to be exposed.
  • The fascia is plicated in the midline using sutures.
  • Permanent mesh reinforces the repair and is anchored through the obturator foramen and exits through small incisions at both sides of your upper inner thigh.
  • The vaginal skin is closed.

Posterior and vault repair:

  • An incision is made to the posterior wall of the vagina.
  • Dissection below the vagina identifies the rectovaginal fascia and opens the space between the rectum and the pelvic floor muscle to the sacrospinous ligaments.
  • Defects in the fascia are corrected by centrally plicating the fascia using sutures.
  • Permanent mesh reinforces the repair and is anchored bilaterally to the pelvic side wall and exits through a small incision approximately 3cm lateral and down from your anus.
  • The vaginal skin is then closed.

Success rate of the surgery is about 85 - 90%. Serious complications are rare with this type of surgery. However, no surgery is without risk and the main potential complications are listed below.

  • 5-15% women will develop recurrent prolapse.
  • Mesh erosion/infection 5-10%. Simple resuturing is usually sufficient but if infection persists further surgery may be required to remove the mesh.
  • 1-5% develop a urinary tract infection.
  • After a large prolapse is repaired urinary leakage may develop that was not present before the surgery 5%.
  • Difficulties passing urine necessitating prolonged self-catheterisation postoperatively 1%.
  • 1-5% constipation or failure to correct symptoms like incomplete bowel evacuation.
  • Inadvertent damage to bladder, urethra, bowel or ureters occurs rarely and is usually repaired during surgery but further surgery may be required.
  • Very rarely further surgery can be required to close a fistula (false tract between vagina and bladder or bowel) (1-2/1000 cases)
  • Excessive bleeding requiring blood transfusion is uncommon (<1%).
  • Clots can form in the legs or lungs after surgery
  • Ongoing vaginal pain and/or persistent pain during intercourse (1-5%) that is difficult to treat and may require further surgeries.

In hospital and recovery

You can expect to stay in hospital between 3-6 days. The vaginal pack 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.

Avoiding heavy lifting (>15kg), weight gain and smoking can minimize failure of the procedure in the long term. If you have any questions about this information, you should speak to Dr. Maher or his team before your operation.