AP Repair with mesh is a procedure indicated for “severe” Pelvic Organ Prolapse (Grade 3 or 4). It aims to return the tissues and organs to their correct positions. Mesh and other synthetic materials are helpful to recreate strength.
The benefits of the operation must be weighed against the risks. A full consideration of the alternative treatments should be made, including the consequences of no treatment.
Make sure that you understand the proposed surgery and to ask as many questions if you are unsure.
GYNECARE GYNEMESH® PS is indicated for the reinforcement of the tissue and vaginal wall with mechanical support for anterior and posterior vaginal wall. In other words, it is the bridging material for the fascia defect. The grid mesh can partly absorb and can be used to cure the “severe” Pelvic Organ Prolapse (POP-Q Grade 3 or 4).
Pain and discomfort during sexual intercourse is one of the most commono symptom reported by patients due to mesh extrusion.In our center,this surgery is not recommended to sexual active women and best for elderly women who do not have sexual relations.
General Notes & Precautions
1) Things about Anterior-Posterior Vaginal Repair with Mesh you should know
- The A-P Vaginal Repair with Mesh is the surgery using the mesh and other synthetic materials to support the vaginal wall and to recreate the strength of the tissue protruding into the anterior and posterior vaginal wall, as well as to revive the prolapse of the bladder and rectum. This is performed by a skilled physician fixing the vaginal wall by substituting the sagging tissues with the mesh, thus anchoring the Pelvic Organ Prolapse and strengthening the vaginal wall.
- The A-P Vaginal Repair with Mesh has limitations and cannot guarantee 100% results and satisfaction because there are too many factors affecting the surgery’s success. It is recommended that the patient obtains the approval of her spouse before surgery, as marriage problems and misunderstanding may occur due to abstinence from sexual intercourse.
- In case of unexpected surgical results or complications, corrective surgery is an option and will be discussed between the patient and the surgeon.
2) Before the procedure
- Dr.Vitasna will conduct a health history, 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 allergies, please inform Dr.Vitasna or our staff before the procedure.
- Dr.Vitasna will educate you with the methods of 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 5-7 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 disruption and refrain from some types of exercise affecting pelvic muscle movement, such as speed running, yoga, swimming, sit-ups and weight training for lower part of the body for 6 weeks after the procedure.
- In our center,this surgery is recommended that the patient obtains the approval of her spouse before surgery, as marriage problems and misunderstanding may occur due to abstinence from sexual intercourse.
3) 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.
Pelvic Organ Prolapse(POP-Q grade 3)
Pelvic Organ Prolapse(POP-Q grade 4)
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) 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 some parts of an excessive anterior vaginal wall tissues (which bulging into the vagina) and supports the saggy tissues with synthetic mesh to recreate the strength of the anterior vaginal wall. Then she will tighten the wound edges with slowly 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 , so the skin(or vaginal mucosa) is closed and the mesh is unable to be seen and felt. –Then Dr.Vitasna will perform the same procedure at the posterior vaginal wall. Therefore, the Pelvic Organ Prolapse will recover and the vagina wall will become more strengthened.
- The patient’s vagina needs vaginal packing for 24 hours after the operation to prevent bleeding and needs to be catheterized 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 anesthesia, 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 drugs, and pain reliever, to lessen the wound pain, and laxative. If the patient cannot be relieved from the oral pain medication , she should inform the nurse and an analgesic injection may be administered.
- The patient is allowed to take a shower on the third day after the procedure or after the removal of the urethral catheter. Cleaning the surgical wound after fecal excretion may be done using water and toweling gently afterwards. The wound will be cleaned with antiseptic daily in the morning or in the everning.
- Urinary frequency or difficulty in urination may be noted due to the tension on the peri-vaginal opening muscle. A urethral 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 have urination herself.
- In the third day after the procedure, Dr.Vitana will ensure that no abnormal bleeding occurs and the patient can have normal urination after the urethral catheter is removed. The patient is asked to review the post-operative care. Then Dr.Vitasna will allow her to return home.
4) Post operative care at home
- For post-operative care, the patient must take antibiotic to protect against a post-operative infection, anti-inflammatory drug to lessen the wound pain, 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 alot of bleeding in the sanitary napkin or a lot of reddish blood clot, 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.
You may return to work within 5-7 days after the surgery. Moreover, the patient should follow the physician’s appointment for follow up examination or treatment.
Anterior Mesh Placement
Posterior Mesh Placement