What is posterior colporrhaphy. Colporrhythmia. The course of the anterior colporrhaphy in detail

With age, especially after natural childbirth, a woman ceases to receive those sensations in bed, as before. This is due to the expansion of the vagina, when the walls lose their elasticity. it natural process, but after all, a young woman in her prime cannot come to terms with this and put an end to her personal life. Both partners should have fun in bed. This problem can be solved surgically by performing a colporrhaphy operation. It is also called vaginoplasty.

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This is an operation aimed at restoring anatomically correct form vagina. In most cases, its narrowing is carried out, because over time it expands. But it may also be that the vagina is naturally too narrow, of some irregular shape, etc. And in this case, colporrhaphy is applicable. This operation is advisable to carry out if:

the vagina has expanded after repeated or difficult childbirth to return the woman the opportunity to experience pleasure during intercourse.
there is a fistula between the ureter and bladder what causes urinary incontinence
I want to improve the elasticity of the walls of the vagina so that the woman herself and her sexual partner can get the most out of sex
there is a prolapse or prolapse of the uterus

The main types of colporrhaphy

There are two main types of colporrhaphy: anterior and posterior. With the anterior, a small section of the vaginal mucosa is excised in the anterior part, with the posterior, respectively, in the back. The walls are then stitched together. Either one of these procedures or both can be carried out.

A narrowing of the vaginal opening may also be performed. In some cases, a special mesh implant to increase the elasticity of the walls. But it is usually installed in women aged 45 and above.

What do seams look like?

It all depends on the specific situation, the site where the operation was performed. Often, combined sutures are applied, since the loads in this area are quite serious. The surgeon may apply submersible catgut sutures. Colporrhaphy: photos BEFORE and AFTER In order for the sutured edges of the vaginal wound to come into contact with wider surfaces and heal faster, when suturing, they often recede from the edge of the wound by 0.7–1.0 cm. Immersion sutures are usually superimposed on the superficial muscles of the pelvic floor and perineum. After the application of submersible sutures, the edges of the wound are additionally sutured with silk ligatures.

What are the consequences of the operation

It is extremely important to follow all the instructions of the doctors after the operation so that there are no complications. Otherwise the following problems may occur:

divergence of sutures, repeated descent of the walls of the vagina
bleeding and internal bruising caused by rupture of sutures
wound infection, etc.

To avoid such problems, within 2 months it is necessary strictly follow all the rules:

give up intimacy
carefully observe intimate hygiene
try to avoid the occurrence of intestinal disorders
empty the bladder on time, and not endure for half a day
try to avoid constipation
take drugs prescribed by the surgeon
avoid heavy physical exertion, etc.

How much does the procedure cost

It all depends on the complexity of the operation and the site on which it is performed. Rates may vary depending on the city, selected clinic, etc.

On average, the narrowing of the entrance to the vagina will cost 40,000 - 80,000 rubles. The price of posterior or anterior colporrhaphy varies from 45,000 to 100,000 rubles. Often, vaginoplasty is accompanied by some other operations, so the price can be higher and reach 200,000 - 250,000 rubles, for example, adding plastic pelvic floor, perineum, etc.

Therefore, you need to find out the cost in advance and be aware of what exactly it includes. Usually everything is included in the price: the operation itself, tests, accommodation in the ward, anesthesia, food, etc. But, this also depends on the chosen clinic.

Reviews about colporrhaphy

Anna, 34 years old, Moscow. She gave birth twice. And each time the birth was difficult, especially the second. After intimacy generally ceased to bring pleasure to either me or my husband. I noticed that the intimacy between us is less and less, because we are tired, because there is no pleasure. I wanted to save my family. No, my husband was not going to leave me because of this, but I'm sure that sooner or later, he would at least get someone on the side. Therefore, I decided to look for ways. At first I tried to do Kegel exercises, but did not achieve any effect. It took a long time to decide on the operation, but I had no other choice. I was not going to put an end to my intimate life at 33 years old. For a long time I was looking for a clinic, a doctor, I read reviews of women who had such an operation. It cost me 83,000 rubles, along with anesthesia, fees, etc. The sensations became brighter, I began to enjoy sex as before.
Rimma, 38 years old, Rostov-on-Don. I did not really believe that such an operation could help. She did it solely for the sake of her husband, so that he could have fun, but I can say I didn’t think about myself. But, I was very wrong, because now I enjoy sex during sex. The operation itself seemed easy to me. Yes, it is relatively simple, but anesthesia and withdrawal from it are quite complex and unpleasant.
Aida, 26 years old, Mirny.I had 2 operations at once: narrowing of the vagina and cervix. I want to immediately, based on my experience, give the girls advice: do the operation not in clinics plastic surgery, but in the hospital, because anything can happen, and there will be doctors who will quickly respond and take action. I did it in the hospital. Everything went well. On the 5th day I was discharged. Then for about 2 more months I avoided intimacy to be sure that everything healed there. And one more piece of advice - do this operation after you decide that you will not give birth again.
Margarita, 24 years old, Essentuki. To me, unlike most women, this operation was done not to narrow, but, on the contrary, to expand the vagina. During the first pregnancy, it turned out that it was narrowed. It seemed good to me and my husband, especially during intimacy. It turned out that this is not the norm. But, during pregnancy, I could not have an operation of such a plan, therefore, during the birth itself, they performed a caesarean section, because. naturally I wouldn't have given birth. After that, I decided that I needed to fix the problem so that I could give birth next time. Everything went well, there was no pain, I followed all the doctor's instructions.

Preparing for surgery is the usual vaginal operations: the evening before the operation - cleansing enema and douching the vagina with some kind of disinfectant solution; early in the morning on the day of the operation - again a cleansing enema. Immediately before the operation, the hair on the external genital organs is shaved off; the vagina, the vaginal part of the uterus and the external genitalia are treated with alcohol and lubricated with 5% iodine tincture. Local anesthesia is usually used infiltration anesthesia 0.5% novocaine solution.

Technique of anterior colporrhaphy operation. The anterior lip of the vaginal part of the uterus is grasped with bullet forceps and pulled so that the vaginal part of the uterus protrudes from the vaginal inlet. Thus, the entire anterior wall of the vagina will be exposed. On it, with a scalpel, the boundaries of the oval flap between the outer opening are marked. urethra(departing 1-2 cm behind it) and the anterior vaginal fornix. The width of the flap should correspond to the excess of the stretched vaginal wall and is determined by eye. A novice operator can be advised not to immediately mark a wide flap with a knife, since if it turns out that it is not wide enough, then the error can be easily corrected by additionally separating the edges of the vaginal wound on the sides and cutting off a narrow strip of the vaginal wall on each side. The resulting oval-shaped flap of the vaginal wall is separated with a scalpel from top to bottom (or left to right). We do not remove, as many surgeons do, the flap in a blunt way, since in this case it is easy to damage the underlying thinned fascia, which, on the contrary, we try to keep intact and strengthen by suturing.

After the flap is removed, for a wider and better convergence of the edges of the vaginal wound during its suturing, these edges are separated by 1-2 cm on each side of the underlying fascia and only then proceed to suturing. Even in the absence of significant protrusion of the wall Bladder(cystocele) we always suture the wound in two floors. The first submersible continuous catgut suture is used to suture the vaginal fascia above the bladder. This suture begins in the upper corner of the wound. On both sides, the refreshed surface of the oval, i.e., the stretched and thinned fascia, is captured on both sides as far as possible from the midline, but, of course, so as not to pierce the walls of the bladder. The farther from the midline, the better the fascia is expressed and the stronger the septum created between the vagina and the bladder will become when sutured. Having sutured the fascia with interrupted catgut sutures (or one continuous one), we connect the edges of the oval vaginal wound. As a result of this technique, not only the vagina narrows due to the removal of the excess of its stretched anterior wall, but also a fascial barrier is created that prevents the formation of a cystocele.

We make a slight deviation from the described technique in those cases when, when the vagina is lowered, there is already a tendency to prolapse of the uterus, which may be indicated, for example, by the presence of a retroversion of the uterus, the correction of which was not included in the plan of the currently undertaken operation. Here, starting the operation of colporrhaphy, we do not delay the cervix, as described above, so as not to aggravate its "tendency" to prolapse. Therefore, in such cases, the vaginal part of the uterus is not captured at all by bullet forceps, but the wall of the anterior vaginal fornix is captured and brought down. The operating field, i.e., the entire anterior wall of the vagina, is exposed: with one clamp, we capture the anterior wall of the vagina along the midline, 1.5-2 cm back from the external urethral opening; the second clamp is also applied to the anterior wall of the vaginal fornix along the midline; with two more clamps we capture the anterior vaginal wall on both sides of the midline, approximately in the middle between the upper and lower clamps, and then we perform the operation in the usual way: the oval flap is removed with a scalpel and the wound is sutured with a two-story catgut suture.

Only in very rare cases, operating with the prolapse of the vagina, you can limit yourself to only one anterior colporrhaphy. As a rule, it is also necessary to perform a posterior colporrhaphy, usually in the form of a colpoperineoplasty.

Tuesday, March 12, 2019

There are many factors under the influence of which the expansion of the vagina and the omission of its walls occur. As a result, a woman not only experiences discomfort along with painful sensations- she is devoid of joy sexual life and the ability to engage in even ordinary daily duties. As a result, the victim is left with one thought - how to reduce the vagina. This task does not belong to the impossible series and is solved with the help of colporrhaphy. Below we will consider what it is, in what cases it is prescribed and why other subtleties of the procedure may be contraindicated.

Types of colporrhaphy

Colporrhaphy is a surgical procedure that changes the size of the vagina. Most often, problems with stretching of the vaginal walls, excessive width of the organ, its prolapse, urinary incontinence occur as a result labor activity or age-related changes. Depending on the factors that caused the changes, the types of colporrhaphy are also selected:

Anterior colporrhaphy. This type of operation is a plastic transformation of the anterior vaginal wall. Intervention is prescribed for prolapse - omission - of the anterior wall of the organ, when it falls out simultaneously with the posterior wall of the bladder.
Posterior colporrhaphy . Plastic surgery affects the posterior vaginal wall and becomes necessary in case of prolapse of the posterior part of the organ, provoked by insufficient tone of the pelvic floor tissues or ruptures formed during labor. Such an intervention may become necessary in case of a threat of uterine prolapse or in the presence of a hernia in the rectum.
Median colporrhaphy. Most often, the operation is prescribed for the final prolapse of the organ to women of the age who do not live sexually. This approach is based on possible complications operations - the consequence may be the impossibility sexual contact and loss of access to the cervix for examinations. A prerequisite is Exploratory survey to exclude predisposition to oncology of the uterine cervix.

When prescribing colporrhaphy, they are guided by secondary changes associated with prolapse of the vaginal walls, both anatomical and functional. For the most part, the decision on surgical intervention is based on the formation of complications in relation to adjacent organs.

Important. With first-degree vaginal prolapse, surgery is not an indispensable solution, it can be prescribed conservative treatment based on special gymnastic exercises to strengthen muscular system vaginal area and pelvic floor.

Indications for colporrhaphy

Kegel exercises do not provide desired effect with the second and third degree of pathology, respectively, surgical intervention becomes a reasonable necessity. In addition to the reasons listed above, indications for organ plastic surgery occur when:

Urinary incontinence due to displaced urethra, excessive stretching of its mouth.
Gas incontinence against the background of insolvency of the anal sphincter due to a displaced rectum, which occurs as a result of prolapse of the posterior vaginal wall.
Difficult or uncomfortable defecation, despite the fact that there is no constipation as such.
Soreness during physical exertion, intercourse, which is explained by the unstable position of the organs of the genitourinary system.

In addition to all of the above, plastic surgery can be performed at the request of the patient, even if there is no organ prolapse. Enough common cause quality deteriorates sexual relations after childbirth, in some cases, surgery is required if there is anatomical features when the partners reveal a discrepancy between the genitals in their size. Surgery may also be required for patients who are not satisfied aesthetic appearance with an enlarged vaginal fissure up to gaping, which is usually observed in those who have given birth many times.

Contraindications for surgery

Unfortunately, in some cases medical indications and the wishes of the patient herself do not play a role, since there are a number of contraindications to plastic surgery. General prohibitions are very similar to restrictions on the conduct of any surgical intervention for which general anesthesia is used. This list includes:

Complicated decompensated somatic pathologies, in which the lesion affects vascular system, kidneys, heart muscle and liver.
Availability infectious diseases in acute form.
The development of acute thrombophlebitis.
Clearly impaired blood clotting.
The recovery period (acute or early) after a heart attack or stroke.
When dangerous combination various injuries.
In the period after childbirth.
Plastic surgery is not advisable in the case of the formation of a malignant pathology and in the presence of diseases that are transmitted through sexual contact.

There are also relative contraindications to which the age bar belongs. Colporrhaphy is not indicated for patients under the age of 18, but such a ban applies only to situations where the changes being made are of an aesthetic nature. If the reason for the operation is deviations that interfere with the functionality of the organs, or there are medical prescriptions for changes, the intervention is carried out regardless of age.

Operation technique

Colporrhaphy is performed exclusively in a hospital, before the operation itself, it is necessary to conduct comprehensive survey aimed at identifying contraindications and clarifying existing violations. The patient is admitted to the hospital a few days before the procedure surgical intervention. Preoperative preparation In addition to the survey, it includes preventive actions aimed at cleansing the intestines, vaginal sanitation. On the eve of the operation, if necessary, the patient should review the menu - the food should be well absorbed, be light enough. The last meal and fluid intake is allowed 12 hours before surgery, taking into account the need for general anesthesia. As for the treatment technique, any manipulations during the surgical intervention are carried out vaginally:

The cervix is fixed with special clamps, taken aside.
Produce excision of the vaginal walls.
At the same time, a rhombus-shaped flap is isolated, and the underlying muscle tissue is sutured and fixed.
The position of the incision depends on the type of intervention scheduled.
After completed main stage procedures, proceed to layer-by-layer suturing.
Separate sutures are applied to muscle tissue, fascia, which dissolve over time.
The mucous layer is closed with a continuous suture.
To avoid the formation of "pockets", the surgeon has to exercise tight control over the position of the edges of the wound.
To prevent the formation of rough scars, it is necessary to exclude the appearance of deformations in the seam area in the form of rollers.
If median colporrhaphy is performed, sutures are applied simultaneously to the back and front walls to connect them, forming two channels on the sides, designed to remove the separated uterus.

The final stage of the operation is the drainage of the vagina, followed by the treatment of the walls of the organ with alcohol. Then a tampon soaked in a disinfectant ointment, most often Synthomycin emulsion, is inserted into the vagina. The accumulated urine is removed using a catheter.

Carrying out colporrhaphy

Colporrhaphy is a surgical intervention performed on the walls of the vagina, correcting defects, including (omission of the bladder) and rectocele (protrusion of the anterior wall of the rectum). Colporrhaphy can be performed on the anterior and/or posterior walls of the vagina. Anterior colporrhaphy is performed for a cystocele or urethrocele, while posterior colporrhaphy is used for a rectocele. The price for anterior and posterior colporrhaphy is practically the same. The main reason for the appointment of colporrhaphy is prolapse. Prolapse is any protrusion of an organ or a certain part of it, in this case through the vagina. At the slightest suspicion of prolapse, you must make an appointment with a specialist. The pelvic organs usually have tissue (muscles, ligaments, etc.) to help hold them in place. Several factors can cause these tissues to weaken, leading to organ prolapse. A cystocele is defined as a protrusion or prolapse of the bladder into the vagina; Urethrocele is a prolapse of the urethra. A rectocele occurs when the rectum protrudes. It is caused by a defect in the rectovaginal fascia. When the part small intestine protrudes into the vagina, this condition is called an enterocele. Uterine prolapse occurs when the uterus moves down. Vaginoplasty is usually not indicated unless symptoms of prolapse begin to interfere with daily life.

prolapse symptoms

A small posterior prolapse may not cause signs or symptoms. Otherwise, you may notice:

A slight bulge of tissue that can sometimes protrude through the vaginal opening
Difficulty during bowel movements;
feeling of rectal pressure or fullness;
Feeling that the rectum is not completely empty after a bowel movement;
Problems during intercourse pain);
(especially during exercise);
Back pain and.

Often, women are prescribed vaginal plastic surgery after childbirth. Factors associated with protrusion pelvic organs, include age, repeated births, hormonal deficiency, current physical activity and previous hysterectomy. Some women perform not for medical, but for aesthetic reasons.

Operation process

Before the colporrhaphy operation, the patient is prescribed a general or local anesthesia. A speculum is inserted into the vagina to keep it open during the procedure. Then an incision is made in the vaginal skin, and a defect in the underlying fascia is identified. The vaginal skin is separated from the fascia and the defect is folded and sutured. Any excess vaginal skin is removed and the incision is closed with stitches. The risks of colporrhaphy include potential complications associated with anesthesia, infection, bleeding, damage to other pelvic structures, dyspareunia (), recurrence of the prolapse, and failure to correct the defect.

In most cases, colporrhaphy can be done without complications, and then the woman can resume normal activity, including sexual intercourse, approximately four weeks after the procedure. After a successful intimate plastic surgery symptoms associated with cystocele or rectocele recede, although separate therapy or intervention is required. Anterior colporrhaphy has approximately a 66% success rate in repairing bladder prolapse.

Training

Before colporrhaphy, a physical examination is required. Most often, for the diagnosis of prolapse of the pelvic organs. A speculum is inserted into the vagina and the patient is asked to tighten or sit upright. The doctor then checks the front, back, top, and sides of the vagina for a bulge. In some cases, physical examination may not allow for a definitive diagnosis. The patient should refrain from eating or drinking after midnight on the day of the colporrhaphy. The doctor may prescribe an enema the night before the procedure if a posterior colporrhaphy will be performed. After surgery, the patient will be put on a liquid diet until he recovers. normal functioning intestines. Your doctor will recommend for a few weeks to avoid activities that may put stress on the surgical site, including heavy lifting, coughing, long walking, sneezing, bowel strain, and sexual intercourse.

The specialists of our clinic will advise on all issues related to the operation and help to ensure the highest level safety and comfort during colporrhaphy.

Frequently asked Questions

What is the recovery period after colpography?

- The first 2-3 days after the colporrhaphy, the patient remains in the hospital under the supervision of doctors. Then the woman can return home, but for another two weeks she is allowed to take only horizontal position- Sitting is strictly prohibited. General rehabilitation period is 2 months.

Tell me, please, with posterior colporrhaphy, will the suture in the vagina be up to the cervix or only 3-4 cm from the entrance?

- The suture in the vagina depends on the severity of the problem before the operation. The larger the problem, the longer the seam will be. Usually the seam is about 3-4 cm in size, but in each case it also depends on the degree of prolapse or stretching of the mucosa.

Omission rear wall The vagina is often combined with an old rupture of the perineum and vagina that occurred during childbirth, and often with a violation of the integrity of the pelvic floor. Excessive, as a result, gaping of the genital slit and protrusion of the vaginal wall can lead to the appearance of leucorrhoea. Patients experience a feeling of awkwardness, pressure on the lower abdomen, when lifting even a small weight, with long walking and other physical stresses.

With a combination of omission of the posterior wall of the vagina with a rupture of the perineum, conservative measures, such as medical gymnastics, vaginal pessaries, etc., do not bring significant benefits. effective method The treatment in these cases is surgery.

In view of these etiological and pathogenetic factors, the method of operation for prolapse of the posterior vaginal wall is most often not only posterior colporrhaphy, but colpoperineorrhaphy or colpoperineoplasty.

The walls of the vagina during omissions, and even more so during prolapses, stretch, and the vagina takes the form of a wide bag. With every strain abdominals, especially when lifting weights, from straining with constipation, etc., the omission increases, the walls of the vagina are more and more stretched and drag along neighboring organs - the bladder and rectum. As a result, cystocele or rectocele, and sometimes both at the same time, are formed. As the formation of a cystocele contributes to the thinning of the connective tissue of the vesico-vaginal septum, so damage to the perineum and thinning of the recto-vaginal septum contribute to the formation of a rectocele.

Operation technique. At recovery operations- posterior colpoperineorrhaphy (colpoperineoplasty) excess of the posterior vaginal wall must be removed. At the same time, the surfaces of the musculo-fascial tissues of the perineum and pelvic floor damaged in the event of a rupture will be exposed (refreshed).

Preparation for colpoperineoplasty surgery is usual for vaginal surgeries. The intestines should be especially carefully cleaned before the operation.

Operation technique. The operation of colpoperineorrhaphy (colpoperineoplasty) begins with cutting out a flap of tissue from the posterior vaginal wall, bordering the perineum. This flap has the shape of an approximately isosceles triangle, or nearly so. The base of the triangle runs parallel to the border between the mucous membrane of the posterior wall of the vagina and the skin of the perineum, and its apex is located on the posterior wall of the vagina along the midline. We are talking about the shape of the flap, close to triangular, because the sides of the triangle should be somewhat concave towards the midline. As a result, the flap somewhat resembles the shape of an anchor. If we adhere to the triangular shape of the flap originally proposed by Gegar, then when suturing the wound and connecting the sides of the triangle to each other in the lower part of the vagina, excessive stress tissues and, as a result, the divergence of the wound in this place.

The size of the removed flap depends on the degree of prolapse and the amount of excess of the posterior vaginal wall. In each individual case, you can change both the height and width of the flap. We determine the width of the flap at its base as follows: we grab it with two clamps or bullet forceps big lips on both sides at such a height that, when the instruments approach, determine the height of the restored perineum. The restored perineum should not cover the external opening of the urethra, otherwise, when urinating, urine will flow into the vagina. The newly formed posterior wall must therefore lie along at least one transverse finger posterior to the urethral opening: the entrance to the vagina in women who are sexually active should be passable for two fingers, in non-living women - for at least one finger. It must be remembered that the height of the perineum and the narrowness of the vagina do not guarantee the success of the operation and do not protect against relapse. Restoration of the muscular-fascial structure of the perineum and pelvic floor is what plays the greatest role in plastic surgery.

As for the upper angle of the triangular, or rather anchor-like flap, the more pronounced the omission, the more it approaches the stage of prolapse, the higher, i.e., the deeper into the vagina should lie the top of the excised flap. If we restrict ourselves to a shorter flap than corresponds to the degree of omission, then it may happen that after the colpoperineoplasty, an excess of the posterior wall remains in the depths of the vagina, and the wall again begins to protrude over the restored perineum. This is what forces us to remove a triangular, or anchor-shaped, flap during a colpoperineoplasty operation not from top to bottom, i.e. from the top of the flap to its base, but from the bottom up, i.e. from the base to the top. Our preference for this method of posterior vaginal flap removal that we use is that top point the incision is not planned immediately. This is very important, because if it is taken too low, then the flap will not be large enough, and if it is taken too high into the vagina, then the excision of the intended flap will be difficult: the vaginal wall does not stretch well, folds form on it, along which it will be difficult draw lines of side cuts. Therefore, we repeat, it is much easier not to fix the top of the flap from the very beginning of the operation, but to outline only its base. To do this, large lips are captured with bullet forceps on both sides at a height corresponding to the height of the restored crotch. The intended height is checked next trick. Bullet forceps, with which large lips are captured on both sides, are brought together and pulled upward towards the urethra, then the height of the future perineum and posterior commissure will be indicated. We remind you again that the level of the perineum should lie posterior to the external opening of the urethra, and the entrance to the vagina should pass one or two fingers. We begin the separation of the flap from its base at the border of the perineum and the posterior vaginal wall, i.e. along the posterior commissure. To do this, we pass the bullet forceps that capture the large lips to both assistants. They pull the posterior commissure to the sides, which serves as the base of the intended flap. Along the adhesion, i.e., on the border between the skin of the perineum and the vaginal mucosa, we make an incision with a scalpel. In order for the incision to be smooth, with sharply defined edges, the scalpel blade should be held perpendicular to the surface being cut. In this case, the edges of the incision move away from each other. Then we grab the vaginal edge of the wound with two clamps in the middle, with the left hand we pull this edge of the wound up, and with the right hand, with a scalpel or the tips of scissors, we begin to separate the back wall of the vagina.

Continuing the separation of the posterior vaginal wall from the bottom up, we pass the clamps to the assistant, and with the fingers of the left hand we protrude the detachable vaginal wall towards the scissors that the surgeon holds in right hand, and continue partly with a sharp, partly blunt way to separate the vaginal wall. After separating the posterior vaginal wall at some distance, we dissect it along the midline between two clamps and continue to dissect until we reach the intended height of the flap. Now we mark the top of the flap with a clamp and cut out an anchor-like flap.

This method allows you to separate the posterior vaginal wall at any length. By protruding into the wound the "lining" of the posterior vaginal wall, which is well accessible for inspection, we are able to navigate in the tissues lying between the vagina and the rectum, which the best way protects the latter from injury and opens up wider access to the muscles and fascia of the pelvic floor and perineum.

This method of flap excision is used by us during the operation of colpoperineorrhaphy, even with a slight omission of the posterior vaginal wall. With a significant omission, especially when full loss vagina, the excess of the walls of the vagina reaches the arches. Therefore, with complete prolapse of the vagina, which is usually observed with complete prolapse of the uterus, it is necessary to excise a flap from the vaginal wall, the top of which reaches the posterior vaginal fornix.

Having separated a section of the vaginal wall for some length, partly in a sharp, partly blunt way, we grab the lower edge of the vagina with two small clamps and with straight scissors we cut the posterior wall of the vagina along the entire length along which the separation was made. The angle of the incision is captured by another large forceps and the vaginal wall is separated in the same way towards the fornix. The newly separated section of the vaginal wall is again cut along the middle line between two new clamps. Thus, the separated posterior vaginal wall is cut in the middle between three or four pairs of forceps.

An excess is cut out from each half of the separated posterior vaginal wall. This is done as follows: with clamps they are pulled into opposite side one half of the flap and cut out the excess with scissors along the line indicated by the dotted line in the figure. Do the same with the other half of the flap. As a result, an anchor-like flap is removed from the posterior vaginal wall, the top of which reaches the vaginal fornix.

The triangular (anchor-shaped) flap required for “refreshment” is removed by many surgeons in the same way as Ott et al. line the back wall of the vagina at the desired height (the apex of the triangle) and stretch the triangular (anchor-shaped) flap intended for removal with these three tools. In the planned boundaries, incisions are made, which should completely cut the skin along the posterior commissure and the vaginal wall along the sides of the triangle. Further, the top of the removed flap is grasped with tweezers or a clamp, and with a scalpel, and partly in a blunt way, the flap is separated down towards the base of the figure.

After the flap from the posterior vaginal wall is removed and the “refreshed” surface of the muscular-fascial tissues of the perineum and pelvic floor lies in front of us, we proceed to suturing.

We use only catgut for immersion joints; we sew the vagina also with catgut and only on the skin of the perineum we impose separate silk sutures or metal brackets. The sutures are applied in layers.

The wound resulting from the excision of the vaginal flap, we begin to sew up from the upper corner; we also use separate catgut ligatures and a continuous catgut suture. We prefer to inject and puncture the sutures on the vagina, stepping back from the edge of the wound by about 1-1.5 cm. Then the stitched edges of the vaginal wound will be in contact with wider surfaces. When approximately half of the wound is sutured, we proceed to the application of submersible catgut sutures. If the prolapse of the posterior vaginal wall is not very pronounced, and most importantly, if there is no large defect in the pelvic floor and there is almost no rectocele, we limit ourselves to placing a one-story immersion suture. Submerged sutures capture fiber and superficial muscles of the pelvic floor and perineum. Levators in mild cases of prolapse are not sutured separately.

Thus, after suturing the vaginal wall and the skin of the perineum, the wound will be sewn up in two floors. Catgut for submerged sutures can be taken thinner than for a surface suture, but at the same time it must be strong enough.

All seams are carried out from left to right (in the transverse direction). Having applied submersible sutures, we again proceed to suturing the vaginal wound. The edges skin wound(the skin of the perineum to be restored) are once again lubricated with iodine tincture and sutured with separate silk ligatures.

In order for the skin around the wound, re-lubricated with iodine, not to be macerated with secretions (this can cause a burning sensation in the patient in the postoperative period and, on this basis, urinary retention), at the end of the operation, the vulva area is lubricated with sterilized vaseline oil.

Colporrhaphy- this is surgical procedure, which reduces the parameters of the female genital organ when it is stretched. Most often, women undergo this operation due to the stretching of the vagina, prolapse of the uterus after childbirth, or due to age-related changes in the pelvic organs.

Feeling of dissatisfaction after sexual intercourse.
Vaginal prolapse (omission) of the walls of the uterus.
Prolapse of internal organs.
Problems with urination (incontinence).
An increase in the slit-like opening between the labia majora, contributing to the penetration of pathogens.

Types of colporrhaphy

Anterior colporrhaphy (suturing the anterior wall of the vagina). Helps strengthen the walls of the urethra, reduces the size of the vagina, eliminates urinary incontinence.
Posterior colporrhaphy (suturing the posterior wall of the vagina). Produced for disorders in intimate life, effectively tightens the muscles of the vagina.
Average surgical procedure. It is carried out in the presence of absolute uterine prolapse.
Levatoroplasty.

strong stretching

Anterior colporrhaphy

This kind surgical treatment is most often used when the bladder is prolapsed by cutting a flap from the sagging part of the vagina, and then suturing the resulting wound with the capture of the bladder fascia. If it is impossible to hold urine due to bladder prolapse, the doctor strengthens the anterior segment of the pelvic floor with a polypropylene mesh.

Posterior colporrhaphy with levatoroplasty

The essence of this method is the excision and stitching of the posterior wall of the vagina. If the operation is performed on a smaller than necessary area of the vagina, then the effect of it will not give the desired result. In the event of an over-resection, the woman will experience discomfort because of "compression" muscle tissue. Therefore, this operation requires high professionalism of the doctor. You can see the transformation of the uterus due to correctly and correctly performed posterior colporrhaphy in the photo.

We are proud to state that our specialists have been successfully performing the procedure of posterior colporrhaphy with levatoroplasty for many years only with positive feedback from patients.

Result:

The acquisition of the normal natural size of the female genital organ, the improvement of its functional abilities.

Restoring the elasticity of the vagina.

Improving the quality of sexual life.

Restoration of the psycho-emotional state.

Restoration of ptosis of internal organs.

Elimination of urinary incontinence, uncontrolled flatulence, etc.

Before holding a corporation, a woman must pass:

A smear to determine the flora and purity of the vagina.

Analysis to determine the blood group and Rh factor.

General and biochemical analysis blood.

General analysis urine;

Blood test for HIV, syphilis, hepatitis B and C;

Analysis for sexually transmitted diseases.

Fluorography, etc.

Contraindications for colporrhaphy

Blood clotting problems.

Diseases of the cardiovascular system.

Mental disorders.

The presence of chronic diseases.

Diabetes.

Inflammatory processes urinary area.

What to bring with you when going to colporrhaphy:

An aqueous solution of "Chlorhexidine" or "Miramistin".

"Diflucan" ("Flucostat") 150 mg two capsules.

Douche.

hygiene products for women.

Ointment "Levomekol".

Take care of yourself after surgery

If some time after the surgical intervention, prolonged pain in the lower abdomen, excessive and bloody issues from the genitals heat, general weakness consult a doctor immediately. AT postoperative period in order to avoid complications, penetration of infection, strictly follow the doctor's indications.

Recovery after vaginal surgery

Observe bed rest within 7-10 days.

Do not sit at a right angle, squatting.

Eliminate physical exercise throughout half a year.

Don't rush to restart intimate life. Wait 1.5-2 months.

Do douching.

Take appointments medicines(antibiotics, etc.).

Get a checkup with a doctor.

Colporrhaphy is a surgical procedure that allows you to reduce the size of the vagina when it is stretched.

Posterior colporrhaphy in our clinic - only positive feedback from patients

What could be more wonderful for a woman than the birth of a child? But, despite the joy of the accomplished miracle, a woman's body is not always able to recover on its own. Often after childbirth or due to uterine pathologies, a woman needs posterior and anterior colporrhaphy.

Consequences of stretching the vagina

Most often, vaginal stretching occurs during childbirth, but it can also occur due to age-related changes in the pelvic organs. In this case, the woman is faced with the following problems:

Dissatisfaction during intercourse - can occur both unilaterally (only for a woman), and for both partners.
Prolapse of the walls of the uterus and uterine internal organs.
Urinary incontinence.
The gaping of the genital slit, leading to the entry of infections into the vagina.

Types of colporrhaphy

In our medical center all types of colporrhaphy are performed:

posterior colporrhaphy (suturing the posterior wall of the vagina);
anterior colporrhaphy (suturing the anterior wall of the vagina);
average colporrhaphy(performed with complete prolapse of the uterus);
narrowing of the entrance to the vagina;
anterior and posterior colporrhaphy followed by levatoroplasty.

Levatoroplasty is Plastic surgery, which is performed on the muscles of the perineum for full recovery pelvic floor. In combination with colporrhaphy, this operation is performed if the walls of the vagina are very stretched or there are old scars from ruptures on them.

Most often there is a need to use the method of posterior colporrhaphy with levatoroplasty. It consists in excision and stitching of the posterior wall of the vagina. This operation must be carried out by a professional great experience work, which will be able to correctly determine the required amount of suturing. If the procedure is carried out on a smaller than necessary area of the vagina, then the effect of it will not give the desired result. In the case of excessive excision, the woman will feel discomfort due to the tightness of the muscle tissue.

You can see changes in the uterus that occur as a result of an effective posterior colporrhaphy in the photo.

Our specialists have been successfully performing the procedure of posterior colporrhaphy with levatoroplasty for many years and receive only positive reviews patients.