Anterior-Posterior Vaginal Repair

 When the muscles and ligaments supporting a woman’s pelvic organs weaken, the pelvic organs can slip out of place (prolapse). Vaginal Relaxation or Pelvic organ prolapse can worsen over time and you may need surgery to fix it.

Anterior-Posterior Vaginal Repair is a surgery for the loss of optimal structural integrity of the front (anterior) and the back (posterior) walls of the vagina, resulting in different organs around the vaginal walls pushing and subsequently a bulge into the vagina or the vaginal opening. This is due to the fact that the muscles of the perineum–the group of supporting muscles located below the low part of the vaginal opening–become thin and the mid-line begins to deviate, thus leading to a weakened, poorly supportive, thinned out perennial body.

Recently, laser has been applicable to the Anterior-Posterior Vaginal Repair.The benefits of Laser Vaginal Rejuvenation includes: more precision and accuracy as a result of the surgical wound control, less blood loss, lower vessel and lower tissue damages and quicker recovery time thus bringing about better results than using the old conventional scalpel procedure.

 The defect of the anterior and posterior vaginal wall is caused by the following:

• Multiple vaginal delivery
• Lack of estrogen resulting from menopause
• Uses of  forceps or vacuum extraction for birth
• Tearing or cutting of the vaginal opening for delivery
• Chronic constipation and stress (affecting bowel movement)
• After a hysterectomy, as it needs the cutting or damaging various pelvic floor muscles including the ligaments and tissues supporting the upper vagina around the cervix.

Symptoms during sexual intercourse:

 pain, no gratification nor orgasm, infrequent sexual intercourse and urinary incontinence while having the sexual intercourse

 Bowel or urinary symtoms:

 chronic constipation, pressure on the vagina, frequent bladder infection, frequent urination and constantly being impelled to urinate, difficulty in completely emptying the bladder and bowel and urinary incontinence while coughing, sneezing or heavy lifting

The different organ prolapses are the following.

1. Cystocele (the bladder protrudes into the vagina)
2. Rectocele (the rectum protrudes into the vagina)
3. Urethrocele (prolapse of the urethra into the vagina)
4. Uterine prolapse (uterus protrudes downward into the vagina)
5. Enterocele (a part of the small intestine prolapse into the vagina)

There are 3 methods of correcting prolapse of the vagina as follows.

1) The Kegel Exercise is safe but would have to take 6 months until results would show, and does not guarantee full effectiveness.

2) Posterior Vaginal Repair is the procedure to narrow the diameter of the vagina which results to a smaller and tighter vaginal canal and opening. However, this procedure also has its limitations to the patients with multiple deliveries. 

3) Anterior and Posterior Vaginal Repair (A-P Vaginal Repair) is the surgical repair of pelvic prolapse by entailing the surgical removal of the excessive anterior and posterior vaginal tissues as well as bladder and rectum prolapse, thereby correcting the prolapse, at the same time tightening the vagina.

General Notes & Precautions

1) Things about  Anterior-Posterior Vaginal Repair you should know

• The  Anterior-Posterior Vaginal Repair is the surgery for the removal of the excessive anterior and posterior vaginal wall tissues bulging into the vagina as well as for the treatment of bladder and rectum prolapse.Consequently, the Pelvic Organ Prolapse or Vaginal Relaxation will be corrected and the vagina will become more tightened.
• The Anterior-Posterior Vaginal Repair has limitations and cannot guarantee 100% results and satisfaction because there are too many factors affecting the surgery’s success.This is not recommended if the patient has no approval by her spouse , as marriage problem and misunderstanding may occur due to refraining from sexual intercourse for quite a time.
• In case of unexpected surgical results or complications , corrective surgery is an option and will be discussed between the patient and the surgeon.

2) Urinary stress incontinence

• In this regard, the  A-P Vaginal Repair is not a permanent solution to Urinary Stress Incontinence, which may be experienced by the patient 5 years after the surgery.

3) Before the procedure

• Dr.Vitasna will investigate your Health history, conduct a general check-up and internal check-up. Should the patient have vaginal fungal or bacterial infection, she should completely treatment  before the procedure to avoid the wound infection.
• However, it is not allowed for those with immunodeficiency and the patient must not become pregnant nor plan to become pregnant in the next 3 months despite no research about the disadvantage to the pregnency and the newborn.
• In case of existing diseases or drug hypersensitivity, please inform Dr.Vitasna or our staff before the procedure.
• Dr.Vitasna will educate you with the methods, procedure and some potential post-operative complications prior to decision-making.  One of the most important preparations you should know is that you should take a rest (refraining from work) and be still for at least 2-3 days after the procedure to enable the wound to heal faster, avoid constipation to reduce pressure on the vaginal wall, have as least movement as possible in the first 1-2 weeks after the procedure to avoid wound disruptionand refrain from some types of exercise affecting pelvic muscle movement, such as speed running, yoga, swimming, sit-ups  , weight training for lower part of the body and sexual intercourse for 6 weeks after the surgery.

4) The cost of the operation

• The cost of the operation will include professional fees for the anesthesiologist and the surgeon, all the instruments, the home medications and medicine used for the procedure as well.
• However, fees for laboratory work-up for other existing diseases that the patient may have and the professional fees for the anesthesiologist and the surgeon for corrective surgery is not included in the package.

  If you decide to have a consultation with Dr.Vitasna, please call or email a staff to make an appointment date for the surgery.

Anterior-Posterior Vaginal Repair is one of the most complex and meticulous cosmetic surgeries performed today. It requires extensive experience, precision, and accuracy to create the optimal results a patient desires and deserves. Many surgeons have little to no experience with this type of advanced cosmetic surgery. Potential patients should research and be conscious of their surgeon’s educational background, training, and practical experience.

The Procedure and Post-Operative Processes

1) The appointment day

• In the appointment day, you are going to meet Dr. Vitasna for discussion.You will be informed of the procedure details again. You may ask Dr.Vitasna for any additional information including consent forms and post-operative instruction form.
• You may also be asked about your expectations for treatment and if you have any allergies or any condition that wouldn’t make you a good candidate for the procedure, as well as other additional inquiries.In case of uncertainty, doubt, worry, or unconfidence for the reason of not informing relatives or husband of the procedure, you should postpone the procedure appointment.
• The patient has to refrain from drinking water or food for at least 6 hours prior to the procedure in order to decrease the risk of food remaining suffocation during or after the procedure.

2) About the procedure

• The procedure is performed in our Operating Room for approximately 1-2 hour under general anesthesia by our board-certified anesthesiologist.While the patient is sleeping, Dr.Vitasna will open and remove the excessive anterior vaginal wall tissues bulging into the vagina. Thus, the anterior vaginal wall tissues are separated, afterwards, the physician will tighten the wound edges with  absorbable suture. The suturing is done along the entire length of the anterior vaginal wall, and the tightening is done alternatively with 2 or 3 layers.
• Then Dr.Vitasna will perform the same procedure at the posterior vaginal wall,she will open and remove the excessive posterior vaginal wall tissues bulging into the vagina. Thus, the posterior vaginal wall tissues are separated forming a wedge shape or an inverted V shape (with its narrow side near the cervix and the wide one near the vaginal opening).  Afterwards, Dr.Vitasna will tighten the wound edges (or two sides of the V shape) with long absorbable suture beginning with the narrow side. The suturing is done along the entire length of the posterior vaginal wall, and the tightening is done alternatively with 2 or 3 layers.Therefore, the Pelvic Organ Prolapse or the Vaginal Relaxation will be corrected and the vaginal wall will become more strengthened.
• Vaginal packing is done for 24 hours after the operation to control and stop the bleeding and a urinary catheter will be inserted for 3-5 days after the operation.

3) After the procedure

• The patient will be monitored at the recovery room for an hour. When the patient is conscious with normal vital signs, the anesthesiologist will allow her to be monitored in the In-patient Building. Nausea and vomiting may be experienced by the patient, as a side effect of the spinal injection or the general anesthetic, but which is noted to be relieved as soon as its effect wears off.
• In the In-patient Building, the patient will be given antibiotics , anti-inflammatory drug to lessen the pain and inlammation , acetaminophen for pain and laxative. If the patient can’t be relieved from the acetaminophen, the nurse will administer an analgesic by injection as ordered by the physician.
• The patient is allowed to take a shower on the third day after the procedure or after the removal of the urinary catheter. Cleaning the surgical wound after fecal excretion may be done using water and toweling gently.Clean the wound with antiseptic daily in the morning and before bedtime.
• Urinary frequency or difficulty in urination may be noted due to the tension of the peri-vaginal opening muscle. As a result, A urinary catheter may be inserted to avoid the retention urine which may be the cause of cystitis especially in the first 3-5 days after the surgery. Then, when the tension disappears, the patient will be able to urinate normally.
• In the third day after the procedure, Dr.Vitasna will ensure that no abnormal bleeding from the surgical wound occurs and the patient can urinate normally after the urinary catheter is removed. The patient is asked to review the post-operative care instructions. Then Dr.Vitasna will allow her to return home.

4) At home for post operative care

• For post-operative care, the patient must take antibiotic to protect against a post-operative infection, anti-inflammatory drug , acetaminophen and laxative drug, as prescribed by the physician, especially the antibiotic which should be wholly completed.
• In the first week after the surgery, clean the wound with antiseptic daily in the morning and before bedtime.Cleaning the surgical wound after urinary excretion may be done with sanitary wipes and after fecal excretion done using water and toweling gently.The patient should try to avoid moisture around the surgical wound to let it heal faster.
• The patient may experience light reddish bleeding out of the vagina in around 1-2 weeks after the procedure. In case of a lot of  bleeding or a lot of reddish blood clot  in the sanitary napkin , swollen reddish wound and high fever, please contact the Hospital for suggestions or come to see Dr.Vitasna  for the surgical wound examination.
• The patient should refrain from jogging , soaking in bath tub or swimming in the pool , speed running or walking , heavy lifting, cycling and sexual intercourse for 6 weeks after the surgery.

The patient doesn’t needs to worry for disorders,complications are in a low rate.You may return to work within 5-7 days. There is no risk of sexual feeling .The patient should follow Dr.Vitasna  appointment for examination or treatment in case of initial complications to avoid worsening.