Abstract
Generic guidelines are applied to reconstructive vaginal operations, so as to convert them to ambulatory procedures. Prototype operations are described and analyzed. These included conceptualizing vaginal prolapse as a type of intussusception caused by vaginal and ligamentous laxity in the middle or posterior parts of the vagina; the avoidance of vaginal excision, excessive tension, and refashioning excess vaginal tissue from width to length or into a partial double-layered repair; the creation of artificial neoligaments; the prevention of urinary retention by avoiding tightness in the bladder neck area; local anesthetic infiltration; and buttressing vaginal tissue during wound healing. A total of 108 patients underwent vaginal surgery on an ambulatory or overnight stay basis, 72 under local anesthesia/midazolam. Minimal postoperative pain and the absence of catheterization reduced hospital stay from a statewide mean of 8 days to 1 day, and return to normal activities from 6 weeks to 7–10 days. Cure rates (18 months) were: uterovaginal prolapse 22/22, infracoccygeal sacropexy 21/23, rectocele 36/38, cystocele/anterior vaginal wall prolapse 21/25. Applied as prototypes to reconstructive vaginal surgery, the operations appear to be as effective as traditional techniques but far less invasive. They have the potential to assist working mothers, the old and infirm, and save the community up to $5,500 per patient. It is hoped that the generic models presented may act as a basis for the future development of ambulatory vaginal surgical techniques.
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Editorial Comment: Although the preliminary reports by the author on this small series of cases is encouraging, confirmation of the applicable usefulness of these techniques and their results and problems created over time will be awaited from other surgeons employing them in sufficient volume. Each of the innovative concepts mentioned is not as simple as it looks on the surface, and requires conviction, precise anatomic knowledge and experience to back enthusiasm with effective performance. Fundamentally the concepts relate to identification of weak or inadequate ligamentous support, treated by reinforcement or replacement.
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Petros, P.E.P. Development of generic models for ambulatory vaginal surgery — a preliminary report. Int Urogynecol J 9, 19–27 (1998). https://doi.org/10.1007/BF01900537
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DOI: https://doi.org/10.1007/BF01900537