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Vaginal wall plasty
Last reviewed: 06.07.2025
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Anterior colporrhaphy
The vagina is exposed in the speculums. The cervix is grasped with bullet forceps and lowered to the entrance to the vagina. An oval flap is cut out from the anterior wall of the vagina, the upper edge of which is 1-1.5 cm below the urethra, and the lower edge is near the place where the cervix transitions to the vaginal fornix.
If the surgeon gets into the layer, then by pulling the upper edge of the flap with Kocher clamps, the vaginal mucosa can be easily separated from the underlying tissues. Then, knotted sutures are applied to the vaginal wall with absorbable suture material, capturing the fascia of the bladder.
Technique of surgery for prolapse of the urinary bladder and anterior vaginal wall. The vaginal mucosa is opened, 1 cm from the external opening of the urethra, with a linear incision to the transition of the vaginal wall to the cervix, separated to the sides, the fascia of the urinary bladder is exposed.
The urinary bladder is separated from the cervix. Then its muscles are sutured with several stitches of absorbable suture material. If necessary, a catheter is inserted into the urethra and the tissues in the area of the urethral sphincter are sutured. Then the fascia of the urinary bladder is sutured so that one part overlaps the other. Free flaps of the vaginal wall are cut and knotted sutures are applied to them with absorbable suture material.
[ Colpoperineoplasty
The colpoperineoplasty operation can be divided into several stages. In the first stage, a diamond-shaped flap is cut out from the skin of the perineum and the mucous membrane of the posterior wall of the vagina, the size of which determines the height of the perineum formed during the operation.
The entrance to the vagina should be passable for two fingers. Too high a perineum prevents normal sexual intercourse.
After the incision, the vaginal mucosa is separated from the underlying tissues and muscles of the perineum to the sides to the line of the lateral incisions of the intended diamond-shaped flap.
After excision of the mucous membrane, a wound is formed that looks like an irregular diamond. At the bottom of it is the anterior wall of the rectal ampulla.
When removing the vaginal mucosa, one should be careful not to injure the rectum, since, especially in the presence of scars, its wall is intimately adjacent to the wall of the vagina, the mucous membrane of which is very thin.
The second stage - levatoroplasty - can be performed in two ways - without and with the separation of the levator legs from the fascial bed. When the levators are connected together with the fascia and surrounding tissue, a sufficiently strong scar is formed, ensuring the normal function of the pelvic floor.
The levators are exposed. A round and thick needle is used to grasp the edges of the levator legs on both sides in the upper part of the wound, the ends of the thread are clamped and pulled upward, while the edges of the levator legs are brought closer together. The suture is not tied. Having retreated 1-1.5 cm from the first suture, the second and then the third sutures are applied closer to the anus.
To isolate the levator crura, an incision is made in the fascia, and then the muscle is isolated from the fascial bed and sutured.
The third stage involves joining the edges of the vaginal mucosa by picking up the underlying tissues by threading them onto a needle. The suture is applied starting from the upper corner of the wound. A Reverdin suture can be applied up to the point where the posterior commissure of the perineum is formed.
The fourth stage of the operation is joining the edges of the levators by tying the previously applied ligatures. Tying of the ligatures begins with the upper ligature. If necessary, additional sutures are applied to the perineal wound to avoid the formation of "empty spaces".
The edges of the perineal skin wound are connected with a continuous intradermal suture using absorbable suture material or with separate interrupted sutures.
Colpoperinoplasty can be performed as an independent operation, but it is often combined with other interventions: anterior or median colporrhaphy, vaginal extirpation of the uterus, etc. All operations that are performed for prolapse and prolapse of the vagina and uterus, based on the etiological factor, should be completed with plastic surgery of the pelvic floor muscles.
Bartholin's gland cyst removal
An incision of 2-3 cm is made in the skin above the largest bulge of the cyst. Then the gland is enucleated and removed using blunt and sharp methods. Hemostasis is performed, first immersion sutures are applied, and then thin sutures with absorbable suture material are applied to the skin. The suture area is treated with an antiseptic.
In some cases, the disease becomes recurrent. After the abscess of the gland is opened, the inflammation subsides and it is no longer palpable. In these cases, a transverse incision is made in the skin of the labia majora in the area of the gland. In this case, its capsule becomes visible and can be enucleated.