Anterior Posterior Repair - Colporrhaphy Cost in India

Anterior Posterior Repair Colporrhaphy in Gynaecology is a minimally invasive procedure to correct the weakened, stretched, or damaged tissues in the pelvic organ due to age or childbirth. This results in organs dropping out of their normal position. The corrective procedure is also called Colporrhaphy. 

When organs drop down, press against the vaginal wall, or slip out of place, it is called Pelvic Organ Prolapse (POP). This creates pain and pressure in the vagina, along with urinary and bowel problems.

This may need surgical procedures to rectify if non-surgical treatments are not effective. 

Types of Pelvic Organ Prolapses (POP)

• Anterior vaginal wall prolapses: Anterior means fronts. This prolapse can happen when a woman had done a hysterectomy. It is called Anterior Colporrhaphy. At the frontal side of the vagina, two types of prolapse can occur:
  • Cystocele: When the bladder drops down into the vagina, it is called Cystocele. This could be mild, moderate and, severe depending on how far it has dropped.
  • Urethrocele: It is possible to have a urethra prolapse when the bladder prolapses because the tube that carries the urine can prolapse. This is called Urethrocele. When both the bladder and urethra prolapse, it is called Cystourethrocele. If it is severe, it may bulge from the vagina.
• Posterior wall prolapses: Posterior refers to the back. This occurs when the tissues between the rectum and vagina stretch and separate from the bone in the pelvic region. Again, there are two kinds of prolapse under this:
  • Rectocele: This happens when the rectum drops down from its normal position, bulges into the back of the vagina which then creates a sag in the back wall of the vagina. It is also called rectal wall prolapse or fallen rectum.
  • Rectal prolapsed: When a part of the rectum turns inside out and pokes out through the anus, a rectal prolapse occurs.

Causes of Pelvic Organ Prolapse (POP)

When there is an increased pressure in the abdomen, POP occurs. It can be due to the following reasons:

• Pregnancy, labor or, childbirth. These are the most common causes.
• Hysterectomy (uterus removed surgically)
• Obesity
• Constipation
• Pelvic organ cancer
• Respiratory problems with a chronic cough

Symptoms of Pelvic Organ Prolapse

Depending on the type of prolapse, different symptoms may occur such as:

• Constipation
• Urinary problems like the constant urge to urinate or leaking
• Painful intercourse
• A feeling that something is falling out of the vagina
• Vaginal spotting or bleeding
• Backache in the lower area of the back
• Feeling of pressure or fullness in the pelvic area

Diagnostic tests for Pelvic Organ Prolapse

Besides a physical examination, the following diagnostic test may be done: 

• Bladder function tests
• Pelvic floor tests
• MRI
• Ultrasound
• CT Scan of abdomen and pelvis
• Urinary tract X-Ray
   

Non-surgical treatments for Pelvic Organ Prolapse

The most suitable treatment depends on the severity of the symptoms and prolapse, age and health, and the desire to have children in the future. If the prolapse ranges from mild to moderate, some simple treatments are available such as:

• Pessary: Usually the first line of treatment, a ring-like device called a Pessary is inserted into the vagina. This device holds and supports the pelvic organ.
• Kegel exercises: It is an easy exercise to strengthen the pelvic muscles. Imagine yourself to urinate, instead of allowing the urine to flow, hold it for 5 seconds, relax, then do it again. 10 sets of this up to 15 times a day is recommended and in time, the prolapsed gets better or may even disappear.
• Biofeedback therapy: This combines learning how to control the pelvic muscles with proper breathing techniques and control of the abdomen.
• Lifestyle changes: These can easily reduce prolapse. In fact, this will also help in being at a risk to prolapse. Lifestyle changes should include:
  • Quitting smoking: This could make you cough and worsen the situation 
  • Maintaining a healthy weight or losing weight if overweight
  • Doing regular pelvic floor exercises
  • Avoiding high impact exercise
  • Avoiding lifting of heavy objects
  • Eating high fiber food to avoid constipation
• Hormone (oestrogen) treatment: To ease vaginal dryness or discomfort during sex, oestrogen is available as a cream to be applied in the vaginal area or a tablet inserted in the vagina.

Surgical techniques for Pelvic Organ Prolapse

It may be noted that surgery only repairs the tissue that bulges and not the underlying weakened tissues. If the bulge is not a bother, surgery may not be needed. But if non-surgical treatments do not work for you, the options below may be explored depending on the location of your prolapse:

• Obliterative surgery: When surgery has not worked, and you cannot go through another procedure, this surgery may be resorted to. This is done to support the organs that have prolapsed. A part or all the vagina is narrowed in size or closed off. Sex is not possible after this.
• Reconstructive surgery: This is carried out to repair the pelvic floor and the organs are brought back to their normal position. It is done with incisions in the vagina or abdomen or through laparoscopy. There are a few options in this surgery:
  • Sacrospinous fixation and uterosacral ligament suspension: The idea is to improve support to the vaginal vault or uterus. To fix the sagging pelvic organs, a vaginal mesh is used to suspend it. 
  • Anterior and posterior colporrhaphy: This is done to make the tissue that holds the pelvic organs stronger and tighter. Using the vaginal mesh, an operation is carried out through the vagina in the anterior to repair a bladder drop that presses against the frontal area of the vagina.
  • With the same vaginal mesh technique, posterior repair is done when the rectum that drops pushes into the back side of the vagina. 
  • Hysterectomy: Women who had their menopause or do not wish to bear more children could have a removal of the uterus to relieve pressure on the vaginal walls and lower the chance of a prolapse return.  
  • Vaginal mesh: To lift the sagging organs into place, a mesh is inserted into the vagina. This should be the option only when other surgery had failed, the tissues are too weak to be repaired and abdominal surgery is not possible. 

Procedure

Before Procedure

Before surgery, certain things may be done like:

• Physical examination. The doctor may use a speculum to check any lumps or prolapse
• Analysis of the patient’s medical history
• Diagnostic tests
• Quitting smoking
• Eating a healthy and balanced diet
• Losing weight if overweight 
• Fasting 8 – 12 hours before surgery
• Cleaning and sanitizing of the vaginal area

During Procedure

• Anterior repair (Anterior colporrhaphy): A vertical incision is done on the vaginal skin at the front. The strong tissues underneath the vaginal skin is then folded and stitched together. This no longer allows dropping of the organ and reliefs the urinary problem.
• Posterior repair (Posterior colporrhaphy): A diamond-shaped or triangular incision is made in the vagina. Some extra skin on the wall of the vagina is also removed. The strong tissues underneath the vagina are stitched together. 
• Sacrospinous Ligament Suspension: At the top of the vagina, an incision is made. The ligaments that hold the vagina are stitched together and these stitches are used to tie the top of the vagina up bringing the vaginal back to its normal position. Depending on how the organ is positioned, anterior or posterior repair may be done.
• Uterosacral Ligament Suspension: A re-attachment of the apex of the vagina, the top vaginal part is stitched in the pelvis to uterosacral ligaments or two strong ligaments.
• Vaginal Hysterectomy: The uterus is removed through an incision made in the vagina. The cut is then stitched up leaving no visible scar.
• Laparoscopic Reconstructive surgery: A one-centimeter incisions are made on the abdomen vertically or transversely with the help of a camera. To attach the top of the vagina to a strong ligament in the pelvic bone, a mesh is used to bring the organ back to its original place. At times, a posterior repair may be done at the same time.

After Procedure

Depending on the surgery, you may stay in a hospital for at least a night.

• A catheter may be used to drain urine from your bladder.
• A temporary gauze may be placed in your vagina for about 24 hours.
• Vaginal bleeding and discharge may occur for about 3 – 4 weeks. It is advisable to wear a sanitary pad instead of tampons.
• Should move around as soon as possible with a few rests in between.
• Stitches will dissolve on its own.
• Bathing or showering can be resumed after hospitalization. Swimming should be avoided for a few weeks.
• Sex should be avoided for about 4 – 6 weeks until you are completely healed.
• Quit smoking.
• Enjoy a healthy lifestyle with exercise.
• A follow-up with your doctor after surgery.