Average colporrhaphy. Vaginoplasty (colporrhaphy): what is it, who needs to do it and how much does the procedure cost. Features of the preparation and conduct of the operation

Colporrhaphy is an operation to suture the walls of the vagina, a type of vaginoplasty. Allows not only to restore the functionality of the organ, impaired due to age-related changes, after gynecological intervention, trauma, difficult childbirth, but also improve the quality of sexual life.

In some cases, the operation is not cosmetic, but therapeutic. If the expansion of the walls affects only the sensations during intercourse, then the omission and prolapse is accompanied by physical discomfort, pain, provokes the development inflammatory processes, urinary incontinence. And surgery is vital.

Price for surgical colporrhaphy

Why do colporrhaphy

Due to the deformation of the vagina, a woman experiences not only general discomfort, but also encounters violations in the work of adjacent organs. Colporrhaphy will relieve pain, help prepare the body for carrying a pregnancy (when the uterus is prolapsed), and eliminate an aesthetic defect.

If there are medical indications for suturing the vagina, then plastic surgery should not be postponed. Against the background of sexual and functional disorders, often occur inflammatory diseases and decreasing overall quality life.

Specialists

What does preparation for surgery include?

Before colporrhaphy, the patient must take tests (their list is determined by the doctor). Kit medical preparations and aids, which will be needed in the postoperative period, must be collected in advance. It includes:

Chlorhexidine solution (can be replaced with Miramistin);
Diflucan;
baby syringe;
gaskets;
compression underwear on the legs (to prevent thrombosis).

If plastic surgery of the labia is supposed to be performed, it is necessary to additionally include Levomekol ointment and underwear (one or two sizes smaller) in the kit.

Before the operation, you need to do an enema and depilation of the pubis. It is forbidden to take blood-thinning drugs.

How is colporrhaphy done?

To carry out the operation, general anesthesia(given intravenously).
Surgical manipulations are performed transvaginally, while the cervix is fixed with special clamps and retracted.
Suturing the walls involves excising a piece of tissue in the form of a rhombus.
Next, the tissues are sutured in layers with self-absorbable threads. The mucous membrane is connected with one continuous suture: the doctor makes sure that no ridges form along the tissue junction zone, which can later turn into scars, and controls the position of the wound edges.

The described technique is used for the anterior and posterior colporrhaphy, while during surgical procedures on the back wall, the levators (perineal muscles that support the pelvic organs) are first sutured and only then the mucous tissue.

Median plasty is done only for women of advanced age (with uterine prolapse), since in the future they will not be able to conduct sexual life. After suturing, access to the cervix is blocked, so the doctor performing colporrhaphy must be absolutely sure that the patient has no signs and predisposition to cancer.

MZhTs doctors use the Surgitron radio wave device during vaginal surgeries. The use of non-invasive tissue excision technique significantly reduces the time postoperative recovery and reduces the risk of bleeding.

How quickly the body recovers

In the postoperative period, women who have undergone colporrhaphy must observe sexual rest for at least 2 months. Usually this time is enough for the body to fully recover.

If complications occur (inflammation, accidental injury to the vagina), rehabilitation may be delayed. To prevent this from happening, it is recommended to strictly follow all the doctor's instructions regarding the frequency of control examinations and intimate hygiene.

Where to do colporrhaphy

Medical Doctors women's center will be able to help not only those women who decide to correct the genital organs by own initiative, but also for those who need vaginoplasty for medical indications. In addition to colporrhaphy, they perform levatoroplasty, restore hymen, correct defects of the labia.

Contact the center if you want to have plastic surgery with cosmetic purpose. After the operation, your sex life will change for the better.

With the omission and prolapse of the walls of the vagina (genital prolapse), anterior, posterior (colpoperineorrhaphy) and median (Lefort-Neigebauer operation) colporrhaphy are performed.

Anterior colporrhaphy (plasty of the anterior wall of the vagina). Indications for anterior colporrhaphy are prolapse of the anterior vaginal wall, prolapse and prolapse of the anterior vaginal wall, and rear wall bladder (cystocele).

Operation technique. The vagina is opened with mirrors, the cervix is grasped with bullet forceps and pulled up to the vaginal opening. On the front wall of the vagina with a scalpel, an oval-shaped section of the mucous membrane is limited. Top edge this area should be at a distance of 1.5-2 cm below the outer opening urethra, and the lower one - 1.5-2 cm from the uterine opening. The upper edge is grasped with a clamp and partly sharp, partly bluntly cut off and excised this section of the mucous membrane. Carry out meticulous hemostasis. Separate sutures deepened with catgut are applied, after which the edges of the vaginal mucosa are sutured with a continuous suture with immersion of the previously applied sutures.

Posterior colporrhaphy (colpoperineorrhaphy). Indications for colpoperineorrhaphy are prolapse and prolapse of the posterior wall of the vagina as a result of previous perineal ruptures, rectocele, decreased tissue tone pelvic floor.

Operation technique. Mirrors are inserted into the vagina, the cervix is grasped with bullet forceps and pulled up. Three clamps separate the triangle on the posterior wall of the vagina, while two of them are placed on the right and left at the border of the transition of the mucous membrane of the vagina into the skin of the perineum, and the third on the posterior wall of the vagina along the midline. Within the framework of this triangle, the mucous membrane of the posterior wall of the vagina is separated by sharp (scalpel) and blunt (tupfer) ways. It should be remembered that the inner surface of the triangle closely borders the anterior wall of the rectum. After removal of this section of the mucous membrane, the levators are exposed and connected using catgut ligatures. Several separate sutures connect the tissues above them, after which the mucous membrane of the posterior wall of the vagina is sutured with a continuous suture. In this case, suture material that is resorbable (Vicryl, Dexon, Maxon, etc.) should be used.

Median colporrhaphy (Lefort-Neugebauer operation). The indication for surgery is complete prolapse uterus in older women who are not sexually active, and if there is confidence in the absence of cancer of the body and cervix.

Operation technique. The anterior and posterior lips of the cervix are grasped with bullet forceps; the uterus and vagina are removed from the pudendal fissure. From the anterior and posterior walls of the vagina, rectangular sections of the mucous membrane, identical in size and shape, are separated and excised. Knotted catgut sutures are first sutured at the anterior edges of the wound surface, then the lateral and posterior ones. The cervix is immersed in the vagina. And on the right and left side channels are left for the outflow of secretions from the uterine cavity and cervix.

The disadvantages of the operation is the impossibility of access to the cervix for examination, in addition, as a result of this surgical intervention, the woman can no longer have a sexual life.

Posterior colporrhaphy

Posterior colporrhaphy is a type of colpoplasty, which consists in resection of the posterior wall of the vagina in order to reduce the volume of the organ. A wide vagina is often the result of childbirth, especially if we are talking about several fruits, and provokes a number of problems, including:

lack of orgasm;
incontinence of urine and gases (is the result of changes in the topography of the pelvic organs);
prolapse and prolapse of the uterus;
hernia of the rectum.

In some cases, the indication for vaginal plastic surgery is only the desire of the patient herself, without any medical indications.

How to prepare?

Preparing for a posterior colporrhaphy like any other plastic surgery begins with a consultation with a surgeon. The doctor conducts an examination and prescribes a number of tests, primarily blood and urine. It is also necessary to do a fluorography, an ECG and conduct some other studies that allow you to get an objective picture of the woman's health status. Having on hand the anamnesis data and the results of the examination, the specialist decides on the possibility of conducting surgical intervention. In the presence of pathological conditions the operation may be denied.

The main contraindications include:

serious illnesses internal organs, which are in the stage of decompensation;
blood diseases that occur with violations of hemocoagulation processes;
malignant tumors;
mental disorders and general instability of the psycho-emotional background (prevents the patient from adequately assessing possible risks and consequences of plastic surgery);
pregnancy;
minor age;
menstrual bleeding.

If at the time of contacting the clinic you are being treated with anticoagulants, you should notify the surgeon in advance and stop taking these drugs a few days before the expected date of the operation.

How is it carried out?

Performing posterior colporrhaphy begins with providing a blockade of pain perception by general anesthesia. Access to the posterior wall of the vagina is opened through a transvaginal incision. Manipulations of a plastic surgeon are reduced to resection of a triangular tissue flap and fixation of the muscles and fascia of the perineum and pelvic floor. After that, sutures from self-absorbable materials are applied. Total duration actions varies from 30 minutes to an hour and is determined by the complexity of each specific case.

a - preparing the patient for surgery, performing general anesthesia, transition to bimanual examination;
b - fixation of the labia with sutures, the imposition of clamps on the mucous membrane of the posterior wall of the vagina;
c - making incisions, removing a triangular flap;
d - dissection of the mucosa, separation of the perirectal fascia.

e - reduction of the rectocele, suturing;
e - tying sutures (in the order of application);
g - excision excess mucous;
h - stitching of the perirectal fascia.

and - suturing;
d - suturing the mucous membrane of the posterior wall, restoring the hymen ring;
k - suturing the perineum;
l - suturing the subcutaneous layer.

m - closure of the subcutaneous layer of the perineum;
n - stitching the skin of the perineum;
o - view after the operation.

How is the rehabilitation going?

During the rehabilitation period, which begins on the second day, when the patient is allowed to leave the hospital (subject to a satisfactory condition), there are pronounced pain in the operated area, including during the act of urination. Mandatory bed rest for a period of at least 7 days. In the first 2-3 weeks, it is better to abandon the sitting position and limit serious physical exercise. Shown special gymnastics, which allows you to normalize the muscles of the pelvic floor (the attending physician will tell you more about this). You can resume sexual intercourse after 30-40 days (minimum). The prognosis is favorable. Intimate plastic surgery can reduce the risk of developing urogenital infections, restore sexual activity, to prevent the displacement of the pelvic organs and vaginal relaxation syndrome, thereby improving the quality of life of a woman, rid her of complexes and self-doubt.

Colporrhaphy was first performed in the 40s of the 20th century. In those years, this operation was carried out for medical reasons: the presence of postpartum and congenital injuries in the vaginal area. After some time, colporrhaphy began to be performed in order to improve the quality of women's sexual life. Nowadays this operation is carried out everywhere, surgeons are actively used modern techniques and techniques for suturing the walls of the vagina.

Indications for surgery

Stretching of the posterior wall of the vagina
Prolapse of the posterior wall of the vagina
Threat of uterine prolapse
Hernia of the rectum
Urinary incontinence
The desire of the patient to narrow the vagina to improve the quality of intimate life

Contraindications for surgery

Diseases of the genitourinary system
Venereal diseases
Thrombophlebitis in acute form
Heart failure
Diabetes
Mental illnesses
Heart failure
Pregnancy
Lactation
Blood clotting disorder
Taking anticoagulants
Benign, malignant neoplasms
Tendency to form keloid scars
Genital skin lesions
Inflammatory processes in the genitals
If the patient is a minor, colporrhaphy is performed only for medical reasons.

Preparing for the operation

The passage of the rear colporrhaphy is possible only after the delivery of all necessary analyzes- check them out complete list. Also, before the operation, it is necessary to undergo a planned medical examination, consult a plastic surgeon. In the course of communication with a specialist, you should obtain information from him regarding the peculiarities of preparing for the operation, its conduct, rehabilitation period and so on. Find out what you need to ask your surgeon here. Are you unable to meet with the surgeon in person? Don't know which specialist to visit? To help you - section Online consultations.

Operation progress

Posterior colporrhaphy in most cases is performed in combination with levatoroplasty - an operation on the muscles of the perineum (levators). They support the pelvic organs, strengthen the pelvic floor, raise anus help the vagina stay in place. If the levators are stretched, as a rule, prolapse of the uterus, vagina, rectum, bladder occurs.

After levatoroplasty, the surgeon excises and stitches a flap of the posterior wall of the vagina. Next, the muscle tissue is tightened and absorbable sutures are applied. The incisions are made on the mucosa, so postoperative scars are invisible at the end of the rehabilitation period.

Operation duration: 1-2 hours

Anesthesia: general, epidural combined with drug sleep

Rehabilitation after surgery

What will be final result anterior colporrhaphy, largely depends on how accurately you follow the surgeon's instructions.

In the first 3-4 days after the operation, you need to stay in the hospital. During the first week, bed rest should be observed and a sitting position should be avoided. The final completion of rehabilitation is 2 months after the operation. At this time, it is forbidden to lift weights, have sex, eat foods that provoke constipation. If these and other doctor's instructions are not followed, stitches may open and/or bleeding may occur, which will lead to the need for another operation.

Photos before and after the operation

Conduct reconstruction and aesthetic operations genital organs qualitatively can surgeons with high qualifications and great experience work. Whether the specialist you are interested in has sufficient professional skills in performing posterior colporrhaphy, you can find out by looking at the photos of his patients before and after undergoing this operation. You can get acquainted with them on the site of a specialist in intimate plastic surgery and on the VseOplastice.ru portal, in the “Photos before and after” section.

Prices for the operation

in Moscow clinics plastic surgery posterior colporrhaphy with levoroplasty today is performed on average for 120,000 rubles. How much you have to pay in your particular case, the specialist will announce to you during an in-person consultation. The price of posterior colporrhaphy consists of several factors: how professional the surgeon is, the clinic is known, what is the economic situation in the country, how much work the specialist has to do. If you want to undergo plastic surgery of the posterior wall of the vagina with big discounts or free of charge, the “Plastika-for-free” portal will help you, where Russian plastic surgeons publish news about performing operations on low prices or free of charge.

Who will have the operation?

To obtain positive results posterior colporrhaphy, choose a trusted specialist for this operation. You can find this as in the list of the best plastic surgeons Russia according to the international award in the field of beauty and health Diamond Beauty, and the rating of leading domestic specialists in aesthetic surgery.

Posterior colporrhaphy- surgical plastic correction of the posterior wall of the vagina. Indications for intimate plastic surgery are the omission and stretching of the posterior vaginal wall with the formation of a rectocele, old postpartum cicatricial deformities. The essence of the operation is to excise the excess mucous membrane of the vagina to restore normal anatomy and narrow the organ. In case of failure of the muscular-fascial structures of the pelvic floor, posterior colporrhaphy is supplemented with levatoroplasty. Stages of the operation: excision and removal of a flap of the posterior wall of the vagina, connection of the edges of the colpotomy wound and the skin of the perineum. The most frequent postoperative complication is a hematoma that does not require repeated surgical intervention.

According to the literature, the history of vaginal plasty began in 1866, when a series of successful operations was first performed to correct genital prolapse. Posterior colporrhaphy with anterior levatoroplasty was proposed in 1889, the main steps of the technique are still used in modern modifications of the intervention. The prolapse of the vaginal wall is not only medical, but psychological problem significantly reducing the quality of life of a woman. The disease is characterized by long lingering course and steady progress pathological process. So far, the most effective treatment for posterior vaginal wall prolapse has been surgery- posterior colporrhaphy.

Indications and contraindications

The main indication for posterior colporrhaphy is the patient's complaints associated with the omission or prolapse of the posterior vaginal wall. Intimate plastic surgery for medical reasons is performed in the presence of the following symptoms: difficulty emptying the rectum, subjective sensation foreign body in the vulva, discomfort in sitting position, drawing pains in the lower abdomen and in the lower back, aggravated by physical exertion.

Posterior colporrhaphy with perineal plasty and reduction in the size of the vaginal vestibule is recommended for patients who complain of dissatisfaction. sex life, dyspareunia ( discomfort during intercourse). At the request of a woman to improve aesthetic characteristics intimate zone colpoperineoplasty is performed in the presence of old cicatricial deformities of the perineum, ruptures and stretching of the walls of the vagina, gaping of the genital gap, which occur after childbirth or mechanical injuries.

Rectocele (diverticulum invagination of the anterior rectal wall towards the vagina) is an indication for posterior colporrhaphy with levatoroplasty, during which defects in the deeper structures of the pelvic floor are eliminated. Various modifications of surgical intervention as the only effective method treatment of genital prolapse is recommended for use in young age after the completion of the childbearing function or at any age with a decrease in the quality of life.

Absolute contraindications to posterior colporrhaphy are acute infectious diseases any organs and systems, decompensated diabetes mellitus with micro- and macroangiopathy, pregnancy and diseases of the blood coagulation system. As a temporary contraindication, a woman's desire to have children is considered (pregnancy and childbirth adversely affect results achieved vaginal plasty). Congenital and acquired deformities of the pelvic bones can also be an obstacle to posterior colporrhaphy.

Preparation for colporrhaphy

Before the intervention, the patient is prescribed laboratory and instrumental research. Protocol preoperative preparation includes UAC, OAM, biochemical analysis blood, coagulogram, determination of blood group and Rh factor, blood tests for dangerous infections(syphilis, hepatitis B and C, HIV), ECG and examination by a general practitioner. To the list gynecological methods examinations before posterior colporrhaphy include a bacteriological smear for the degree of purity of the vagina, an oncocytological smear from cervical canal, extended colposcopy , pelvic ultrasound . Upon admission to the hospital, the operating gynecologist performs a vaginal examination and rectal examination.

On the evening before and in the morning on the day of the posterior colporrhaphy, it is necessary to do cleansing enema. hairline in the area of the external genitalia and perineum, you need to shave in the morning on the day of the operation in order to prevent the appearance of pustular rashes. A few days before posterior colporrhaphy, it is recommended to sanitize the vagina antimicrobial suppositories(at night) and daily douching using antiseptic solutions (in the morning). With varicose veins immediately before surgical intervention compression required lower extremities using an elastic bandage or medical knitwear. Before entering the operating room bladder catheterized with a Foley catheter. In menstruating women, posterior colporrhaphy is performed immediately after menstruation (day 6-8 of the cycle), so that the main reparative processes are completed before the next menstrual bleeding.

Methodology

Posterior colporrhaphy is performed under epidural anesthesia or endotracheal anesthesia. The patient is placed on her back, shifted as far forward as possible (so that the buttocks protrude above the edge of the operating table) with hips widely apart, which are fixed with leg holders (position for lithotomy). External genitalia and inner thighs are treated alcohol solution antiseptic. The operating field is fenced off with sterile linen. The labia minora is parted to the sides and fixed with interrupted sutures to inner surface hips.

For safe separation of the flap, hydropreparation is performed by infiltration physiological saline into the submucosal layer. Posterior colporrhaphy begins with the excision of a flap of the posterior wall of the vagina of a triangular shape. The length and width of the flap are determined by the degree of prolapse and the size of the rectocele. The border between the skin of the perineum and the vaginal mucosa serves as the base of the triangular flap, and its apex is the posterior wall 2 cm below the cervix in the midline. In women who are sexually active, the restored size of the entrance to the vagina is formed passable for two fingers.

The first stage of posterior colporrhaphy begins with clamping the area of the mucous membrane of the posterior wall of the vagina and the skin of the perineum to be removed. Pulling the edges of the vaginal wall on the clamps, the surgeon cuts the flap from the bottom up in a sharp and blunt way. After excision of excess tissue in the presence of a rectocele further actions doctors are aimed at restoring and strengthening defects in the deep spaces of the pelvic floor (levoroplasty).

The final stage of posterior colporrhaphy is the closure of the defect in the vaginal and perineal mucosa. The edges of the vaginal wound are often connected with continuous sutures with a self-absorbable thread. The edges of the skin of the perineum, together with the underlying tissues, are usually restored with separate silk or nylon sutures. After completion of all stages of posterior colporrhaphy, the vagina is tamponed with a tight gauze swab, which is removed in a day. The average volume of intraoperative blood loss is 100-150 ml. The duration of the operation ranges from 30 to 60 minutes.

After colporrhaphy

The duration of hospitalization depends on the volume of surgical intervention and the characteristics of the course of the postoperative period. In some clinics, posterior colporrhaphy is performed according to the principle of “one-day surgery”, the patient is allowed to go home as early as 4 hours after the operation. Suture material, used in posterior colporrhaphy to restore the integrity of the vaginal wall, resolves on its own within 6 weeks. Perineal sutures made of non-absorbable suture are removed after 14 days.

For 6-8 weeks, the patient must strictly observe sexual rest. Within 7 days after posterior colporrhaphy, sitting at a right angle is not allowed; squatting is not allowed for 2 weeks. Wash your perineum after every toilet antiseptic solution. To prevent inflammatory processes for 5-7 days appoint antibiotic therapy, sanitation of the vagina with complex antimicrobial and antifungal suppositories. In the early postoperative period dysuric disorders (reaction to urinary catheter), tissue edema, bloody issues from the vagina. A follow-up examination on a gynecological chair after posterior colporrhaphy is carried out in a week. When returning to sexual activity, the first time it is necessary to use lubricants.

Complications

Most frequent complication posterior colporrhaphy are postoperative hematomas of small size, which are usually emptied or resolve on their own. To rare complications include bleeding, perforation of the rectal wall, divergence postoperative sutures. The disadvantage of posterior colporrhaphy is the high frequency of relapses of prolapse of the vaginal wall and rectocele, which, according to the literature, range from 6 to 30%.

Cost of posterior colporrhaphy in Moscow

Surgical correction of the posterior vaginal wall is a classic surgical technique used in many public and private medical institutions capital Cities. It has a democratic value. The price of posterior colporrhaphy in Moscow is determined by several parameters, including the volume of intervention, the type of anesthesia (endotracheal anesthesia, epidural anesthesia), the qualifications of the operating surgeon and the duration inpatient treatment. AT public hospitals the operation, as a rule, is cheaper than in private medical and diagnostic centers.