Anterior colporrhaphy. Posterior colporrhaphy. Rehabilitation and possible complications

Anterior colporrhaphy with fascia plasty Bladder (plastic cystocele) is performed with prolapse of the anterior wall of the vagina, accompanied by prolapse of the bladder and its dysfunction, often urinary incontinence. Anterior colporrhaphy consists in excision of the vaginal flap, stitching and strengthening of the walls of the vagina, elimination of the hernia of the bladder by plastic surgery of the vesico-vaginal fascia.

Omission and prolapse of the anterior vaginal wall, the formation of a cystocele and, as a result, urinary incontinence in women usually develops due to birth trauma. Complicated childbirth is accompanied by damage (tear) of the vesico-vaginal fascia, connective tissue and muscle elements, with the help of which the fascia is attached to the bladder and the anterior wall of the vagina. This violates support function fascia for the bladder and urethra. Intra-abdominal pressure leads to overstretching and thinning of the vesico-vaginal fascia along the midline, and then to the omission and prolapse of the anterior vaginal wall, the formation of a hernia of the bladder.

The prolapse of the walls of the vagina and the bladder is an indication for anterior colporrhaphy with plastic surgery of the vesico-vaginal fascia, during which fascio-muscular defects are eliminated. Anterior colporrhaphy is performed under general anesthesia. From the vaginal access, a median longitudinal incision is made on the anterior wall of the vagina, starting 0.5-1 cm below the urethral opening and ending 1 cm below the anterior lip of the cervix. in a sharp way the vaginal mucosa is separated, releasing the urethral canal and the bottom of the bladder. Then a wide dissection of the fascia is made and it is separated from the wall of the bladder. The muscles of the urethra and bladder triangle are sutured with interrupted sutures. The free edges of the fascia flaps are superimposed on each other and are sutured using the duplication (“coat”) method with continuous rows of catgut sutures. In conclusion, the vaginal mucosa is sutured with the capture of the tissues of the cervix to maintain the elevated position of the bladder.

After anterior colporrhaphy, strict bed rest is prescribed for 1 week, antibiotic prophylaxis infectious complications, anesthesia. Sitting is allowed 2 weeks after the intervention. Patients who have undergone anterior colporrhaphy are recommended to do physically light work, wearing a special support bandage. physiotherapy, physiotherapy.

COLPORAPHIA (colporrhapia; Greek kolpos female womb, vagina + rhaphe suture) - plastic surgery to remove excess tissue from the walls of the vagina and stitch together the fascia located under them.

There are anterior, median and posterior K. Features of the posterior K. technique - see Colpoperineoplasty. Anterior K. is usually combined with closure of the fascia over bladder, and back K. - with plasticity of muscles pelvic floor. Both types of K. p. are produced with the omission and prolapse of the walls of the vagina, with mechanical damage vagina and perineum (during childbirth, during a fall, etc.). Median K., also performed in Persianinov's modification (see Lefort-Neigebauer operation), is used in women old age. In the presence of diseases of the cervix and vagina, median K. is contraindicated.

front K. performed in the position of the patient, usual for vaginal operations, under local infiltration anesthesia. For? For better separation of tissues, it is advisable to infiltrate the vaginal wall with novocaine solution. After treatment of the external genital organs with alcohol and iodine, the cervix is ​​exposed with the help of mirrors, the anterior lip of the cervix is ​​grasped with forceps and brought down to the entrance to the vagina. After that, on the exposed anterior wall of the vagina with a scalpel, an oval flap is planned for removal: the upper corner of the flap should be at a distance of 1.5-2 cm from the external opening of the urethra, the lower one - at the level of the anterior vaginal fornix. The width of the flap depends on the degree of stretching of the vaginal wall and the severity of the cystocele (see): the more the vaginal wall is stretched, the wider the flap should be. Then an incision is made that penetrates to the loose fiber layer above the fascia between the vaginal wall and the bladder. The incision is not made very deep due to the danger of injuring the bladder. Separation is usually started from the upper corner with a sharp and somewhat blunt way with a scalpel and small gauze tupfers (Fig., 1). After the flap is removed, the bleeding is carefully controlled. If the descent of the vaginal walls is combined with a cystocele, after removing the flap, it is necessary to separate the edges of the vaginal wound along the entire length (Fig., 2) to a width of 1-1.5 cm for better convergence. Then the bladder is separated from the cervix by a sharp and blunt way. On the legs of the fascia, going from the bladder to the cervix, interrupted catgut sutures are applied. The exposed vaginal fascia above the bladder, starting from the upper corner of the wound, is sutured to reduce bladder protrusion and create additional support for it in the form of thickened fascial tissue using one of the following methods: continuous catgut suture (Fig., 3), separate knotted catgut sutures or purse-string seam. After suturing the fascia, the edges of the vaginal wound are connected with catgut sutures (Fig., 4). Vaseline oil tampons are inserted into the vagina.

If there is no independent urination within 2-3 days, bladder catheterization is performed 2 times a day. For better healing postoperative wound it is advisable to hold the stool for 3 days.

Bibliography: Makarov R. R. and Havelov A. A. Operative gynecology, L., 1977; Multi-volume guide to obstetrics and gynecology, ed. L. S. Persianinova, vol. 6, book. 2, p. 442, M., 1961; Persianinov L. S. Operative gynecology, M., 1976, bibliogr.

I. M. Gryaznova.

Anterior colporrhaphy is an operation performed when the anterior wall of the vagina is lowered. With a slight prolapse of the anterior wall of the vagina, the position of the bladder may not be disturbed. Plastic surgery in such cases, always carried out simultaneously with the operation of restoring the integrity of the perineum, is reduced to the following.

The patient is laid down, as for vaginal operations, the operating field is treated and isolated with sterile linen. Vaginal mirrors expose the cervix, fix it with forceps and bring it down to the vaginal opening or beyond it and down.

The operation can be performed under general anesthesia and under local anesthesia novocaine. It is also rational to use local infiltration anesthesia for the purpose of tissue hydropreparation.

From the stretched anterior wall of the vagina, an oval-shaped flap is cut out, the most pointed end of which begins at a distance of 1-2 cm from the external opening of the urethra; the second, more blunt, end reaches the transition of the mucous membrane from the anterior part of the vaginal fornix to the cervix (a).

The circumferential incision of the vaginal wall should be made with a sharp scalpel. The incision is made correctly if the edges of the wound diverge by 0.5-1 cm, that is, if it has penetrated into the layer of loose connective tissue. Separation of the flap outlined in this way should be started from the external opening of the urethra towards the cervix (b).

If the outlining incision is made superficially, the flap of the anterior vaginal wall is separated with great difficulty, the separation is accompanied by significant bleeding. It must be remembered that the thickness of the vaginal wall is approximately 0.3 cm, and only in older women is it thinner. If you make a deeper incision, you can injure the bladder. It is also necessary to correctly determine the width of the flap so as not to narrow the vagina too much and not make the operation meaningless by cutting too narrow a flap.

After removing the outlined flap, the edges of the vaginal wound should be separated by about 1 cm to the sides, and then connected with knotted catgut sutures (c).

When stitching the edges of the vaginal wound with a continuous catgut suture, the vagina along the suture line can be pulled together in the form of an accordion and, therefore, deformed, and its front wall is also shortened and fixed at the lower edge pubic symphysis, therefore it is better to apply knotted sutures, without tightening them too much, since the tissues of the vagina are easily cut through. As a result of improper operation, the resulting scar fixes the cervix in the lowered state. Therefore, the patient's condition will worsen as a result of this operation.

At the end of the operation, it is necessary to pack the vagina tightly (for 12-24 hours), so that it expands well along the suture line.

Anterior colporrhaphy with bladder reposition

With a significant omission of the anterior wall of the vagina, the bladder also descends over time, forming a cystocele, therefore, using only the anterior colporrhaphy, a good result cannot be achieved.

To perform an anterior colporrhaphy operation, when the anterior wall of the vagina and bladder are lowered, a flap is outlined and separated, as in the previous operation. After that, the edges of the vaginal wound are cut off in all directions by 1-2 cm, depending on the width of the removed flap (a).

Separation is best done with blunt curved Cooper scissors, cutting the bundles connective tissue, between the vagina and the bladder, which, as the edges of the wound separate, is increasingly freed. Further, pulling the cervix on itself and downwards, and lifting the bladder upwards with a tupfer, the stretched connecting bundles connecting the bladder and uterus are cut with scissors. After their dissection, the bladder is easily separated with a tupfer, blunt ends of scissors or a finger wrapped in gauze from the cervix up to the peritoneum of the vesicouterine cavity.

The dissected bladder together with its fascia should be sutured with a purse-string suture or nodular

with catgut sutures. When tightening the sutures, care must be taken not to infringe on the walls of the bladder; in case of infringement due to impaired blood circulation, its wall can become necrotic with the formation of a fistula.

It is better to suture the bladder with knotted sutures placed across, on the "legs" of the bladder and perivesical tissue together with the fascia (b, c, d).

Only after that, the edges of the vaginal wound are also connected with catgut sutures (e); moreover, at the anterior part of the vaginal vault, 2-3 sutures should also be stitched into the cervical tissue. As a result, the bladder is fixed in an elevated

position.

Therefore, the main points of the anterior colporrhaphy operation when the anterior wall of the vagina and bladder are lowered are as follows:

    excision of an oval flap from the anterior wall of the vagina;

    separation of the walls of the vagina by 1-2 cm from the edges of the wound to the sides;

    separation of the bladder from the cervix;

    suturing of the bladder;

    connection of the edges of the vaginal wound.

Anterior colporrhaphy with bladder fascia plasty is a method surgical intervention, during which the prolapse of the anterior part of the vaginal wall, caused by a cystocele or urethrocele, is corrected, and the natural position of the bladder neck is restored.

A change in the position of the bladder, a violation of its functioning and urinary incontinence are the main indicators of a cystocele. If during the examination by the gynecologist the patient has clear signs pathology, then an anterior colporrhaphy is prescribed. In the process of anterior colporrhaphy, the surgeon cuts out a section of the vagina that looks like a flap, after which the walls of the vagina are sutured and strengthened. During the anterior colporrhaphy, a cystocele is removed by the method plastic surgery bladder fascia.

Women who have undergone difficult pathological childbirth, as a result of which an injury was received, quite often they turn to specialists with the problem of prolapse, prolapse or hernial protrusion of the anterior wall of the vagina, accompanied by urinary incontinence. In the course of long and difficult childbirth a woman can get an injury to the fascia of the vagina and bladder, connective tissues and muscles, thanks to which the fascia is kept near the anterior wall of the vagina and bladder. The result of such an injury is the inability of the fascia to support the weight of the bladder and urethra, as a result of which the fascia stretches and eventually descends, up to complete loss, a cystocele is formed.

Plastic surgery of the fascia of the bladder can be performed both for medical and aesthetic purposes. Anterior colporrhaphy with plasty of the bladder fascia is indicated for patients who have been diagnosed with prolapse or prolapse of the bladder and vaginal wall.

Before anterior colporrhaphy, the patient is injected general anesthesia. The operation is performed through the vaginal access. In the middle along the anterior wall of the vagina, the surgeon makes an incision. The tissues are dissected, not reaching the marginal lines. Then there is a separation of the mucous membrane of the vagina, released urethra and fundus of the bladder. Manipulations are performed sharp method. After that, the connective membrane of the bladder is dissected and separated from the organ. Muscles that hold the urethra and the bottom of the bladder, located between the mouths of the ureters and inner hole urethra, sutured with separate stitches. The edges of the fascia that remain free are also subject to suturing. To do this, use the duplication method. Absorbable sutures are placed in continuous rows. Upon completion of all manipulations, the surgeon sews up the vaginal mucosa, while picking up the tissues of the cervix, which allows the bladder to be in the correct position.

Patients who have undergone anterior colporrhaphy with bladder fascia plasty must strictly observe bed rest within seven days. You can switch to a sitting position after 14 days.

Surgical reduction of the entrance to the vagina, the operation of colporrhaphy, solves many women's issues: aesthetic, sexual, psychological, functional. Colporrhaphy - plastic surgery of the walls of the vagina - involves a decrease in the volume of the vagina in order to eliminate pathologies this body and the associated discomfort. The operation improves muscle elasticity intimate zone women, thereby returning joy sexual life.

Depending on the omission of which wall bothers the woman, an anterior and (or) posterior colporrhaphy is performed. Often complex vaginoplasty is required for women after a difficult or multiple childbirth. However, this does not mean that the joy of motherhood irreversibly leads to problems in the vaginal area. It all depends on individual features anatomy of a woman. Often after first birth reproductive organs women independently "return" to their former position. Anterior and posterior colporrhaphy is also indicated for problems associated with uterine prolapse or prolapse, as well as bladder dysfunction.

Indications for colporrhaphy

    Anterior and posterior vaginal plasty is performed for the following reasons:
  1. Congenital pathologies of the female genital organs (infection hymen entrance to the vagina, aplasia (absence) of the vagina, lack of communication between the uterus and the vagina, and others);
  2. Postpartum trauma to the vagina is the most common reason for intimate plastic surgery- colporrhaphy (excessive volume of the vagina, a decrease in the lumen in the vagina, a change in the position of the lumen of the vagina due to scars and scars, the appearance of fistulas;
  3. Age-related changes: prolapse of the genital organs, decreased elasticity of the muscles of the perineum and ligamentous apparatus. In these cases, the woman experiences a sensation foreign body in the vagina, observes the prolapse of the walls of the vagina and uterus with attempts, tension of the muscles of the press.

Anterior-posterior colporrhaphy is usually performed on women between the ages of 25 and 55. One of the most common motives for performing colporrhaphy is dissatisfaction with sexual life due to the increased volume of the vagina. However, the most common cause is the consequences of childbirth: vaginal tears, episiotomy scars, sprains and tears. muscular frame. With inaction, ptosis, prolapse of the walls of the vagina, disturbances in the functioning of the bladder, and sometimes prolapse of the uterus can occur in the future. It is necessary to eliminate postpartum disorders after the tissue healing process is completely completed, that is, not earlier than 6-8 months.

Anterior-posterior colporrhaphy is usually performed on women between the ages of 25 and 55.

Anterior-posterior colporrhaphy, as a rule, is performed together with levatoroplasty - a tightening of the pelvic floor muscles. In practice (in 60-70% of cases), women more often seek plastic surgery of one wall of the vagina.

Colporrhaphy: the technique of the operation

Plastic surgery of the anterior wall of the vagina (anterior colporrhaphy, anterior colpoplasty) is surgery, the purpose of which is to change the position of the bladder, removing it from the vagina. During the operation, functional disorders of the small pelvis are eliminated, the quality of a woman's sexual life improves, and urinary incontinence is prevented.

Plastic rear wall vagina (posterior colporrhaphy, posterior colpoplasty) is a surgical operation, the purpose of which is to solve functional disorders small pelvis, improving the quality of a woman's sexual life. For a number of reasons, this type of correction is carried out much more often than plastic surgery of the anterior wall of the vagina.

The technical features of the operation for reconstructive surgery on the vagina (colpoperineolevathoroplasty) have been developed a lot. Which technique is suitable for a given patient depends not only on her initial complaints and motivation, but also on her plans for the future. It is important to assess the physiological and psychological factors, which became the reason for the appeal. AT last years methods of vaginal plastic surgery using synthetic materials have proven themselves well. Reinforcement of the vagina gives a 100% guarantee against prolapse of the pelvic organs. But you need to know if a woman is going to give birth in the future.

Gynecologists should do vaginal plastic surgery. It is very important. There are a lot of nuances that are not known plastic surgeons. Even minimally invasive procedures (laser vaginal rejuvenation, injections hyaluronic acid) should be done by doctors, not cosmetologists.

Colporrhaphy: postoperative period

Despite the technical complexity of intimate plastic surgery, after the operation "colporrhaphy" there is a relatively quick and easy recovery period. When a woman leaves the clinic, she can return to her daily activities while avoiding intensive physical activity. In general, rehabilitation after colporrhaphy lasts up to 2 months.

    Recommendations for rehabilitation period after colporrhaphy:
  • The first 2 weeks should be avoided sitting position, in order to avoid complications after colporrhaphy in the form of suture divergence;
  • The first 1.5-2 months after the operation, it is necessary to refrain from intimacy;
  • Up to 2 months, the ban on physical activity, sports: squats, weight lifting, and other activities that may contribute to the divergence after colporrhaphy sutures;
  • Discharge after colporrhaphy can cause a burning sensation in a woman, therefore, after the operation, it is necessary to comply with the requirements of sterility - douching the vagina with a solution of "Chlorhexidine";
  • Be sure to take antibiotics and other drugs prescribed by a doctor;
  • Follow a diet focused on limiting the intake of foods that cause constipation.

After complete colporrhaphy rehabilitation involves repeated visits to the clinic by the patient. During the examinations, the surgeon monitors the healing process and, if necessary, assists in the processing of sutures. The specialists of our clinic are ready to do everything to make it more comfortable for a woman to endure these temporary difficulties. According to many patients, after colporrhaphy, the most difficult thing is to give up sexual life for 2 months, but the pleasure that a woman experiences after recovery deserves such “preparation”.

Reinforcement of the vagina gives a 100% guarantee of the absence of prolapse of the pelvic organs

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