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Vaginal Sagging Vaginal Surgery

Sacrospinous ligament fixation

This surgery; It is the suturing and hanging of the vagina or cervix to the sacrospinous ligament, a pelvic ligament, in patients who have had the uterus removed. No incision is made on the patient's abdomen, the entire operation is done through the patient's vagina.

Which diseases are treated with this surgery?

The main purpose of this operation is to correct uterine or vaginal prolapse (vaginal prolapse may occur in women who have had their womb removed before). It is also beneficial in urinary bladder and bowel prolapse.

If the tissues and muscles around the vagina become weak; The organs located in the pelvis are displaced downwards, that is, they hang down. There may be sagging of both the uterus, the bladder, and the last bowel and vagina. In most women, a few of these hang together.

Vagina Prolapse Vaginal Surgery

How to fix the sacrospinous ligament?

The operation is usually performed under general anesthesia (sleeping during the entire operation) or spinal anesthesia (awake but completely numb from the waist down). The uppermost part of the vagina or cervix is ​​sutured to the sacrospinous ligament. Usually the right side ligament is used. There is no incision in the patient's abdomen.

Can other surgeries be performed simultaneously?

During sacrospinous ligament fixation surgery;

  • Genital aesthetics, vaginal repairs and vaginal tightening operations
  • Urinary incontinence operations can be added.

All operations can be performed in a single session. However, some surgeons do not prefer to perform these operations in a single session. Discuss this issue with your doctor.

What is the benefit of sacrospinous ligament fixation?

  • The problem of sagging disappears
  • Some patients experience significant improvement in urinary incontinence
  • There is improvement in overactive bladder syndrome

What are the risks of sacrospinous ligament fixation surgery?

General Risks

  • Anesthesia-related risks: If you have heart or lung problems, are overweight and smoke, the risks increase, but the anesthesiologist will take the necessary precautions. It is beneficial for you to quit smoking and lose weight. If you have drugs you use, be sure to give the list to your physicians.
  • Bleeding
  • Infection (5-13%): usually resolves with antibiotics.
  • Deep vein thrombosis (coagulation in a vein): This clot can rarely break into the lungs, creating a serious condition.
  • We recommend blood thinners, compression stockings and early mobility after surgery.
  • Wound infection: The sutures inside the vagina can be infected from time to time.

Risks specific to prolapse surgery

  • A new sagging after surgery: The risk of uterine prolapse is 15-30%, and the risk of bladder sagging is 15-20%. Not lifting heavy, losing or gaining weight, not pushing on the toilet are important precautions.
  • Symptoms do not improve: Although urinary incontinence symptoms sometimes improve after surgery, they can sometimes get worse and worse. Sometimes there may be difficulty in urinating. (make sure to keep your legs open while you are using the toilet, do not bring your knees together)
  • Constipation: This problem improves over time with plenty of water and fiber foods.
  • Painful sexual intercourse: It usually resolves spontaneously in 6 weeks. However, since the sagging improves, there are usually positive developments in sexual life.

Risks specific to sacrospinous ligament fixation

  • Urinary bag and bowel injuries
  • Hip pain: It is encountered in 1/10 patients, but it regresses over time. However, in cases where the pain does not go away, the stitches may need to be opened.

In hospital after sacrospinous ligament fixation surgery

  • Painkillers: Epidural or intravenous pain medications can be used.
  • Your urinary catheter stays the same day, it is usually removed the day after surgery.
  • Vaginal tampon: After the operation, surgeons usually use tampons, the inserted tampon is removed the next morning of the surgery.
  • Vaginal bleeding: Mild vaginal bleeding may occur for a few days after surgery.
  • Eating and drinking: Your doctor will want you to eat and drink as early as possible.
  • Coagulation prevention: You will be asked to get out of bed and walk a lot on the day of surgery. In addition, in some patients, blood thinner injections are tried to prevent coagulation. This treatment can sometimes continue for 7-10 days after surgery.
  • Discharge: Usually, you can go home after 1-2 days of hospital stay. If you need a rest report and don't forget to ask for your surgery epicrisis.

At home after sacrospinous ligament fixation surgery

  • Lots of movement, walking
  • Step-up shower or bath
  • You should not wash the inside of the vagina or use tampons for 6 weeks
  • After 2 weeks there is sometimes a slight vaginal bleeding as the stitches dissolve, no need to worry
  • You may feel slightly tired and tired for 1 month, this will pass in time.
  • Especially in the first 1-2 weeks after the surgery, you should avoid movements that may stretch the stitches. You should not be constipated or lifting heavy.
  • Drink lots of water, eat lots of vegetables (especially broccoli, oats) and fruit
  • If your cough persists, you should have it treated immediately
  • After 6 weeks, you can gradually increase your mobility and activity
  • You should be able to return to your normal activities 3 months after surgery
  • You can drive after 3-6 weeks
  • You should definitely take care not to lift heavy objects.
  • Vaginal healing takes 6 weeks, then sexual intercourse can occur. It is not safe before 6 weeks. At first, sexual activity may be uncomfortable for the woman, but it will improve over time. We recommend the use of lubricant during this period.
  • You are usually called by your doctor at 3 and 6 weeks and at 6 months.

What are the situations when I need to call the doctor right away?

  • Excessive vaginal bleeding
  • Bad smelling discharge
  • High fever
  • Burning when urinating, bloody urine
  • Severe pain
  • Swelling, redness in the leg
  • Chest pain, shortness of breath

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