Anterior Posterior Vaginal Wall Repair for Pelvic Organ Prolapse 1

blue-shutterstock_94733821When the muscles and ligaments supporting a woman’s pelvic organs weaken, the pelvic organs can slip out of place (prolapse). Pelvic organ prolapse can worsen over time and you may need surgery to fix it.

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 perineal body.

The cause of pelvic wall relaxation is a weakening of the pelvic support structures (see the Figure 1 and Figure 2). The pelvic organs include the vagina, uterus, bladder, and the rectum. These organs are kept in place with the help of 3 support systems from muscles, ligament sheets and fascia. 

During the course of childbirth, as the baby journeys through the birth canal, these supports become damaged and tend to become weakened. This weakening increasingly worsens, and further on down the line, may cause the pelvic organs to shift from their normal positions.

The underlying cause of pelvic support defects are:

  • bullet_tickBirth trauma such as multiple vaginal deliveries
  • bullet_tickDifficult or prolonged deliveries (the use of forceps)
  • bullet_tickAging (lack of estrogen resulting from menopause)
  • bullet_tickTearing or cutting of the vaginal opening for delivery
  • bullet_tickChronic constipation and stress (affecting bowel movement)
  • bullet_tickAfter a hysterectomy, as it needs the cutting or damaging the ligaments and tissues supporting the upper vagina around the cervix

Every once in a while, the weakening of the muscles and tissues of  the vaginal wall can occur to women who have never birthed a child. In these women, the underlying cause(s) may will be:

  • bullet_tickObesity
  • bullet_tickAbnormal increases in abdominal pressure.
  • bullet_tickInherited weakness of the supporting tissues of the pelvic floor.
  • bullet_tickExtraordinary tension placed on the supporting tissues due to a chronic cough.

Anterior Posterior Vaginal Wall Repair is a surgery for the loss of optimal structural integrity of the anterior and the posterior walls of the vagina, resulting in different organs around the vaginal walls pushing and forming a bulge into the vagina or the vaginal opening.

Because of technological advances, gynecology procedures involving the use of laser have been utilized in anterior – posterior vaginal repair. Advantages of laser over old, conventional scalpel procedure include: less blood loss, less risk of vessel and tissue damage, precise and accurate surgical wound control, and quicker recovery time and better overall results

There are 4 methods of correcting prolapse of the vagina as follows.

  • bullet_tick1) The Kegel exercise is safe but would have to take 6 months until results would show, and does not guarantee full effectiveness.
  • bullet_tick2) The 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 in patients with multiple deliveries.
  • bullet_tick3) The Anterior and Posterior Vaginal Repair is the surgical repair of pelvic prolapse by entailing the surgical removal of excess anterior and posterior vaginal tissues as well as bladder and rectum prolapse, thereby correcting the prolapse, at the same time tightening the vagina.
  • bullet_tick4) The Incisionless Laser Vaginal Tightening is a new trend of innovation to the Cosmetic Gynecology for mild to moderate pelvic prolapse, this procedure has limitations and cannot guarantee the results and satisfaction. After the procedure the patient will experience less pain and no bleeding, compared with the surgical or incision laser method. The post-operative care is only refraining from sexual intercourse for 1-2 weeks after the procedure.

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 the patient desires and deserves. Many surgeons have little to no experience with this type of advanced gynecology surgery. The patient should research and be conscious of the surgeon’s educational background, training, and practical experience.

General Notes & Precautions

1) Important points to consider about A-P vaginal repair

  • bullet_tickAnterior Posterior Vaginal Repair is a surgical procedure designed for the removal of excess anterior and posterior vaginal wall tissues bulging into the vagina. Consequently, the Pelvic Organ Prolapse or Vaginal Relaxation will be corrected and the vagina will become more tightened.
  • bullet_tickAnterior Posterior Vaginal Repair has limitations and cannot absolutely ensure satisfactory results because there are so many factors affecting the surgery’s success. The procedure is not recommended unless the patient has any discussion with her spouse because this may lead to problems and misunderstandings caused by refraining from sexual intercourse for quite a time.
  • bullet_tickIn case of unexpected surgical results or complications, corrective surgery is an option and will be discussed between the patient and the surgeon. If correction surgery is needed due to the complication of the surgery, all expenses for services and treatment will no longer be charged to the patient.
  • bullet_tickHowever, if the unsatisfactory results occur due to the complication from the patient’s non-compliance with the doctor’s orders, the patient will be charged accordingly.

2) Urinary Stress Incontinence and A-P Vaginal Wall Repair

  • bullet_tickIn 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.

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