Anterior and Posterior Colporrhaphy

Brielle Bowyer&

Tyson Howes

What is this procedure? An Anterior and Posterior Colporrhaphy is done to repair

herniations of the bladder and/or rectum through defects in the vaginal vault.

Causes Difficult Vaginal Births

› Multiple Births› Use of forceps during delivery› Perineal tears and episiotomy during delivery

Strain from heavy lifting Chronic cough or constipation Weakening of vaginal muscles

Equipment Preferred Stirrups Bovie Headlamp

Instrumentation and Supplies

Vaginal hysterectomy set

D & C set (if needed) Basic vaginal set-up Surgeon-specific

sutures and dressings.

Operative Prep Anesthesia

› General Position

› Lithotomy Prep

› Vaginal Prep› Indwelling Catheter

Draping› Lithotomy

Anterior Repair Procedure Transverse incision made at the union of the vaginal

mucosa and cervix.› Continued down to pubovesical cervical fascia.

The vaginal mucosa is dissected from the pubovesical and cervical fascia and is opened in the midline until 1 cm-ish from urethral meatus.› Dissection continues until the bladder and urethra are

separated from the vaginal mucosa. Synthetic absorbable sutures placed in the pubovesical

and cervical fascia.› Cystocele is reduced.

Excessive vaginal mucosa is removed. Vaginal mucosa is closed in the midline with interrupted

0 synthetic absorbable sutures.

Cystocele Repair

Posterior Repair Procedure Allis-Adair clamps are placed on the posterior vaginal

mucosa and elevated to create a triangle. An Allis clamp is placed at the top of the rectocele in the

midline.› A transverse incision is made at the posterior fourchette.› Blunt dissection is used to separate the posterior vaginal

mucosa from the perirectal fascia. V-shaped portion of the mucosa is excised as determined

by extent of repair required. Vertical incision is made in the posterior vaginal mucosa

and the edges are retracted.› The perirectal fascia is bluntly dissected from the posterior

vaginal mucosa. Rectocele is reduced with finger and levator ani muscles

are sutured together. Closure and dressing

Rectocele Repair

Post-Op Considerations Immediate Post-op Care

› Transport to PACU.› Observe color and

amount of urine in urine drainage bag.

Prognosis› Return to normal

activities.

Complications› Post-op bleeding

› Hematoma› UTI› Inability to urinate

or stress incontinence

› Shortened or narrowed vagina

› Rectovaginal fistula› Wound infection› Recurrence of

herniation