Posterior Vaginal Repair & Perineoplasty

Indication: Treatment of rectocele (rectum bulges or herniates forward into the vagina) and defects of the perineum (area separating entrance of the vagina and anus)
This is to correct defects in the rectovaginal fascia separating rectum and vagina while allowing bowel function to be maintained or corrected without interfering with sexual function.

Surgical Technique

  • An incision is made on the posterior wall of the vagina starting at the entrance and finishing at the top of the vagina.
  • Dissecting the vagina and rectovaginal tissue from the vagina until the pelvic floor muscles (Puborectalis) are located (A).
  • Defects in the fascia are corrected by centrally plicating the fascia using delayed absorption sutures (B).
  • Occasionally a permanent mesh support is placed over the repair to strengthen it (C).
  • The perineal defects are repaired by placing deep sutures into the perineal muscles to build up the perineal body.
  • The overlying vaginal and vulval skin is then closed
  • A pack is usually placed into the vagina and a catheter into the bladder at the end of surgery

Serious complications are rare with this type of surgery. However, no surgery is without risk and the main potential complications are listed below.

  • Failure to correct symptoms like incomplete bowel evacuation
  • Painful intercourse in 1 – 5%
  • Mesh erosion in <10%
  • Blood loss requiring transfusion <1%
  • Constipation
  • Inadvertent damage to the rectum is very uncommon
  • Urinary tract infection in 1%
  • Small risk of clots forming in the legs or lungs after surgery. (<1%)
  • Confidence and comfort during coitus is likely to be increased as a result of the prolapse being repaired, although painful intercourse can occur in 1%
  • Return of the prolapse in 1

In hospital & Recovery
After the operation you will have an IV drip in your arm for fluids and pain relief. You can expect to stay in hospital between 3 – 4 days. The vaginal pack, and catheter, is removed on the first day or when your bladder empties appropriately.

In the early postoperative period you should avoid situation where excessive pressure is placed on the repair ie lifting, straining, coughing and constipation. Maximal healing around the repair occurs at 3 months and care needs to be taken during this time. If you develop urinary burning, frequency or urgency you should see your local doctor.

Vaginal spotting or discharge is not uncommon in the first 10 days but should be reported to your doctor if heavy or persistent. You will be reviewed at 6 weeks by your consultant. Sexual activity can usually be safely resumed at this time.You can return to work at approximately 4 – 6 weeks depending on the amount of strain that will be placed on the repair at your work and on how you feel.
Avoiding heavy lifting (>15Kg), Weight gain and smoking can minimise failure of the procedure in the longterm. If you have any questions about this information, you should speak to the doctor or his team before your operation