Name of the Procedure:

Vaginal hysterectomy for uterus 250 g or less with repair of enterocele.
Common Names: Vaginal hysterectomy with enterocele repair.

Summary

A vaginal hysterectomy is surgery to remove the uterus through the vagina. This specific procedure also includes a repair of an enterocele, which is a hernia in the vaginal wall involving the intestines.

Purpose

The procedure addresses medical conditions like uterine fibroids, endometriosis, uterine prolapse, chronic pelvic pain, and cancer. The goal is to remove the uterus to alleviate symptoms, improve quality of life, and treat underlying health issues. Additionally, repairing the enterocele helps to prevent intestinal bulging into the vaginal area.

Indications

• Uterine fibroids
• Endometriosis
• Uterine prolapse
• Chronic pelvic pain
• Abnormal uterine bleeding
• Cancer (in certain cases)
• Symptoms of hernia in the vaginal wall or enterocele.

Preparation

• Preoperative fasting for at least 8 hours.
• Adjustments or cessation of certain medications as per doctor's advice.
• Possible preoperative diagnostic tests such as blood work, pelvic ultrasound, or MRI.
• Bowel preparation may be required.

Procedure Description

1. The patient receives anesthesia.
2. A catheter is inserted into the bladder to collect urine.
3. The surgeon makes an incision at the top of the vagina to access the uterus.
4. The uterus is detached from the surrounding tissues and blood vessels and then removed through the vaginal opening.
5. The surgeon then repairs the enterocele by reinforcing the weakened area with stitches.
6. The vaginal incision is closed with absorbable sutures.
7. The patient is taken to the recovery area.

Duration

Typically, the procedure takes about 1.5 to 2 hours.

Setting

The procedure is performed in a hospital or surgical center, typically in an operating room.

Personnel

• Gynecologist or gynecological surgeon
• Anesthesiologist
• Surgical nurses
• Possibly a surgical assistant.

Risks and Complications

• Infection
• Heavy bleeding
• Damage to surrounding organs (bladder, intestines)
• Anesthesia-related risks
• Blood clots
• Rare: Ongoing pelvic pain or adhesion formation.

Benefits

• Relief from chronic pain, heavy bleeding, and other symptoms.
• Correction of uterine prolapse.
• Correction of enterocele, reducing discomfort and risk of complications.
• Improved quality of life.

Recovery

• Hospital stay of 1-2 days is common.
• Expect some vaginal bleeding and discomfort.
• Pain management typically involves prescribed medications.
• Avoid heavy lifting and strenuous activities for 6-8 weeks.
• Follow-up appointments to monitor recovery.

Alternatives

• Abdominal hysterectomy
• Laparoscopic hysterectomy
• Non-surgical treatments like uterine artery embolization, hormonal treatments, or watchful waiting. Alternatives may come with different recovery times, risks, and benefits that should be discussed with a healthcare provider.

Patient Experience

Patients may experience moderate discomfort postoperatively, managed by pain relief medications. Some light bleeding or discharge is normal. Most patients fully recover in 6-8 weeks, with normal activity resuming gradually. Rest and proper care are crucial for a smooth recovery.