Dense vaginal adhesions after traditional colporrhaphy. A case report
IUGA Academy. Mikos T. Jun 30, 2018; 213054; 480 Topic: Pelvic Organ Prolapse
Themistoklis Mikos
Themistoklis Mikos

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480

Dense vaginal adhesions after traditional colporrhaphy. A case report

Mikos, T1; Pantazis, K1; Dampala, K1; Abo Elftooh, H1; Grimbizis, G1

1: 1st Department Obstetrics & Gynecology, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece

Introduction: Vaginal adhesions after pelvic reconstructive surgery (VAaPRS) are reported to be independent from the pre-operative prolapse stage and the type of surgical intervention. There are studies that report rates of postoperative vaginal adhesions to be as high as 10%. Since VAaPRS are under-reported, there are no specific intra- or post-operative guidelines for the prevention of their formation. However, common surgical knowledge and clinical experience indicates that an early first post-operative visit that includes a digital vaginal examination could offer the chance of recognition and easy dissolve the adhesions without any further treatment.

Objective: To describe a case of a patient who developed dense VAaPRS shortly after an anterior-posterior vaginal repair and had to undergo surgical correction under anesthesia.

Methods: Case report. Urogynecology Department of a tertiary gynecology center. A patient had an anterior and posterior vaginal repair. During the early post-operative period she presented complaining of severe pain at the genital area.

Results: A 62-years-old patient with no history of malignancy and no previous prolapse surgery was diagnosed with stage III symptomatic cystocele (POP-Q Aa=+3, Ba=+4), asymptomatic stage I uterine prolapse (POP-Q C=-4), asymptomatic stage II rectocele (POP-Q Ap=0, Bp=0), no urinary incontinence and no overactive bladder symptoms. The patient underwent a native tissue anterior and posterior repair with perineorraphy. She was discharged home on antibiotics and analgesics two days after the procedure, remaining complication free and asymptomatic. She was acutely seen in the outpatient department three weeks post-operatively, complaining of persistent pain at the genitalia. The clinical examination revealed a thick and dense anteroposterior VAaPRS 5cm from the introitus; the adhesion was obliterating most of the vaginal lumen, thusmaking it was impossible to visualize the uterine cervix. She was initially treated with local estrogens and antibiotics. Two months after the vaginal repair she underwent a surgical revision of the VAaPRS under anesthesia, as a day case, with no further complications. On her scheduled six-week postoperative appointment she remained free of symptoms and the clinical examination was unremarkable with no signs of adhesions.

Conclusions: Vaginal reconstructive surgery appears to withstand a risk of postoperative adhesions, which may be dense enough to necessitate a full revision under anaesthesia in order to divide. A strategy that adopts an early postoperative examination may be useful to early detect and digitally split adhesions in the outpatient clinic before they grow dense and necessitate surgery under anaesthesia to correct.

References:

  1. Int Urogynecol J 2016; 27: 141-145.
  2. Am J Obstet Gynecol 2005; 192: 1573-7.
  3. Int Urogynecol J 2013; 24: 1853-7.

Disclosure:

Work supported by industry: no.

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