GENERAL SURGERY INFORMATION

in pathogenesis, everybody acknowledges the leading role of the pelvic diaphragm incompetence. surgeries aimed at restoration of the pelvic diaphragm are limited by exposure and enhancement of levators (colpoperineoplasty), as well as by the use of cellular endoprostheses.

INDICATIONS:

• perineum deformity
• pelvic diaphragm muscles incompetence
• incompletely closed vulvar slit and increase in the non-specific colpitis rate connected with it
• discomfort of sex life
• first degree colpoptosis

COUNTERINDICATIONS

• third-forth degree vagina purity
• acute or exacerbated genital chronic conditions
• severe extragenital diseases

Note: forthcoming pregnancy in the future is not a counterindication. the surgery performed is not a direct indication for cesarean delivery.

CHECK LIST FOR THE PATIENT EXAMINATION AND PREPARATION FOR SURGERY:

• general blood and urine tests
• flora and antibiotic sensitivity test swabs
• WR
• blood sugar
• ecg, therapeutist examination
• biochemical blood analysis, coagulogram during an intravenous anesthesia
• external sex organs and vagina sanitation during 3 days before by any means

PRIOR TO THE PROCEDURE

The patient should observe everyday intime hygiene and depilation measures. the procedure is carried out after emmenia (the procedure should not be carried out immediately after and immediately prior to emmenia). îne month before the surgery the patient should stop taking oral contraceptives, 10-20 before the patient should stop taking anticoagulants, antiaggregants (aspirin etc.). if an anticoagulant therapy is necessary, the physician in charge should be warned about it.

OPERATIVE SITE

• in a minor operation room of gynecology departments
• in a surgery of women's health clinics and medical centers.

ANESTHESIS

• phlebonarcosis
• local anesthesia with a 2 % lidocaine solution of peripheral pudendal nerve branches and peripheral lumbosacral nerve plexus branches

SURGERY TECHNIQUE

after treatment of the surgical field, insections are made on perineum skin, vaginal mucous membrane 1-1,5 cm inwards from the epithalamic commissure and 2,0 cm at the both sides of the epithalamic commissure towards the superior borders of the ischial tuberosities. the insections are made with a scalpel. a monofilament synthetic long-dissolvable clockwise indented suture is put through these insections. the suture is put through fibers of the superficial transverse muscle of perineum. the ends of the suture are tied together without overtensioning to form a correct anatomy of the pelvic diaphragm and vaginal orifice. skin insections are repaired with polyglycolide 2/0 sutures which are removed in 5 days.

NOTE:

localization of skin insections is determined strictly individually depending on the intensity and extent of anatomo-physiologic distortion ratio of the perineum and vulva.

POSTOPERATIVE CARE:

• one dose intravenous or intramuscular antibiotics delivery
• nonsteroidal antiinflammatory drugs
• rectal suppositories (ketonal, diclofenac) during 6-7 days
• treatment of suture lines with betadine for 5-7 days
• no need for general anesthesia
• one may seat on the perineum
• sexual rest for 3 weeks.