57106 Vaginectomy, partial removal of vaginal wall

Name of the Procedure:

Vaginectomy
Common Name(s): Vaginal wall resection, Partial vaginectomy
Technical/Medical Term: Partial vaginectomy

Summary

A partial vaginectomy is a surgical procedure that involves the removal of a part of the vaginal wall. This procedure is typically used to address certain medical conditions affecting the vagina.

Purpose

A partial vaginectomy is performed to remove diseased or damaged tissue from the vaginal wall. This can be due to conditions such as vaginal cancer, severe infection, or precancerous lesions. The goal is to remove the problematic tissue while preserving as much normal vaginal function as possible.

Indications

• Diagnosed vaginal cancer or precancerous lesions
• Severe or recurrent vaginal infections that do not respond to other treatments
• Chronic vaginal pain or bleeding with identified pathology
• Physical abnormalities or trauma to the vaginal wall

Preparation

• Patients may be required to fast for 8-12 hours before the procedure.
• Medications such as blood thinners may need to be adjusted or paused.
• Preoperative diagnostic tests may include pelvic exams, biopsies, and imaging studies like MRI or CT scans.
• Patients may need to undergo a medical clearance exam to ensure they are fit for surgery.

Procedure Description

1. The procedure begins with the administration of general anesthesia or regional anesthesia with sedation.
2. The patient is positioned to allow access to the vaginal area.
3. The surgeon makes an incision in the vaginal wall and carefully removes the diseased or damaged tissue.
4. The surgical site is then inspected to ensure all problematic tissue is excised.
5. The remaining edges of the vaginal wall are sutured together to promote healing.
6. Sterile dressings may be applied to protect the area during the initial healing phase.

Duration

The procedure typically takes about 1 to 2 hours, depending on the extent of tissue removal required.

Setting

A partial vaginectomy is usually performed in a hospital operating room or an outpatient surgical center.

Personnel

• Surgeon specialized in gynecology or oncologic surgery
• Anesthesiologist or nurse anesthetist
• Surgical nurses and/or operating room technicians

Risks and Complications

• Common risks: infection, bleeding, pain at the surgical site
• Rare risks: injury to surrounding organs, complications related to anesthesia, scarring or narrowing of the vaginal canal
• Risk management: close postoperative monitoring, prophylactic antibiotics, and pain management strategies

Benefits

• Removal of diseased or cancerous tissue
• Reduction or elimination of symptoms such as pain, bleeding, or infection
• Potential improvement in quality of life
• Benefits typically realized shortly after recovery, though improvement continues as healing progresses

Recovery

• Post-procedure care includes pain management, antibiotics to prevent infection, and wound care instructions.
• Patients should avoid heavy lifting, strenuous activities, and sexual intercourse for a specified period as advised by the surgeon.
• Follow-up appointments are crucial for monitoring healing and addressing any complications.
• Recovery time varies but generally ranges from 4 to 6 weeks.

Alternatives

• Radiotherapy or chemotherapy for cancerous conditions
• Less invasive procedures or medications for infections
• Observation and regular monitoring for certain precancerous conditions
• Pros: Non-surgical options may have fewer immediate risks.
• Cons: Less definitive treatment, potential for incomplete symptom resolution or ongoing issues.

Patient Experience

• During the procedure, the patient will be under anesthesia and should not feel pain.
• Postoperative pain and discomfort are common, managed with prescribed pain medication.
• Patients may experience fatigue and a need for rest during the recovery period.
• Emotional support and counseling may be beneficial, particularly if the procedure is part of cancer treatment.