58280 Vaginal hysterectomy, with total or partial vaginectomy; with repair of enterocele

Name of the Procedure:

Vaginal hysterectomy with total or partial vaginectomy and repair of enterocele

Summary

A vaginal hysterectomy with vaginectomy and enterocele repair is a surgical procedure involving the removal of the uterus (and sometimes parts of the vagina), along with the repair of an enterocele, which is a hernia in the vaginal wall containing intestines. This procedure is typically performed through the vaginal canal.

Purpose

The procedure addresses issues such as uterine prolapse, chronic pelvic pain, endometriosis, cancer, or severe pelvic inflammatory disease. The goals are to alleviate symptoms, improve quality of life, and restore normal pelvic anatomy and function.

Indications

• Uterine prolapse
• Chronic pelvic pain or discomfort
• Endometriosis
• Heavy or irregular menstrual bleeding
• Pelvic inflammatory disease not responding to other treatments
• Suspected or confirmed pelvic cancer
• Presence of an enterocele causing symptoms

Preparation

• Fasting for at least 8 hours before the procedure
• Adjusting or stopping certain medications as advised by the healthcare provider
• Preoperative screening tests such as blood work, pelvic ultrasound, and ECG
• Bowel preparation may be required in some cases

Procedure Description

1. The patient is placed under general or regional anesthesia.
2. The surgeon makes an incision in the vaginal wall to access the uterus and, if necessary, parts of the vagina.
3. The uterus (entire or part) and, if indicated, part of the vagina are removed.
4. The surgeon repairs the enterocele by repositioning the protruding intestines and reinforcing the vaginal wall.
5. Incisions are closed with dissolvable sutures.
6. A vaginal packing or catheter may be placed temporarily to assist with healing.

Duration

The procedure typically takes 2 to 4 hours.

Setting

The procedure is performed in a hospital or surgical center.

Personnel

• Gynecologic surgeon
• Anesthesiologist or nurse anesthetist
• Surgical nurse
• Possible additional assistants or residents

Risks and Complications

• Infection
• Bleeding
• Damage to surrounding organs (bladder, intestines)
• Blood clots
• Adverse reaction to anesthesia
• Persistent pain or discomfort
• Vaginal fistula (rare)
• Scar tissue formation

Benefits

• Relief from symptoms like pelvic pain, abnormal bleeding, and pressure
• Improved quality of life
• Prevention of cancer progression (if applicable)
• Restoration of normal pelvic anatomy

Recovery

• Initial hospital stay of 1 to 2 days
• Gradual return to normal activities in 4 to 6 weeks
• Postoperative care including pain management, avoiding heavy lifting, and pelvic rest for a specified period
• Follow-up appointments to monitor healing and address any concerns

Alternatives

• Uterine sparing procedures (uterine suspension, pessary use)
• Medical management for symptom relief (hormonal treatments, physical therapy)
• Abdominal or laparoscopic hysterectomy
• Each alternative has varying degrees of invasiveness, recovery times, and suitability based on individual patient conditions

Patient Experience

During the procedure, the patient will be under anesthesia, so there will be no pain. Postoperatively, there may be discomfort, managed with pain medication. Patients might experience temporary vaginal discharge or bleeding, bloating, and fatigue. Emotional support and reassurance are often necessary to help patients adjust to the changes following the surgery.