Name of the Procedure:

Vaginal Hysterectomy for Uterus Greater Than 250 g with Repair of Enterocele

Summary

A vaginal hysterectomy is a surgical procedure involving the removal of the uterus through the vaginal canal. When the uterus is particularly large (greater than 250 grams) and there is a coexisting condition such as an enterocele (a herniation of the small bowel into the vaginal area), the procedure includes repairing the enterocele to restore normal pelvic anatomy.

Purpose

This procedure addresses the conditions of an enlarged uterus that might cause symptoms such as heavy bleeding, chronic pelvic pain, or other related issues. The repair of the enterocele prevents the small bowel from herniating into the vagina, which can cause discomfort and further complications. The goals are to alleviate symptoms, improve quality of life, and prevent the recurrence of the hernia.

Indications

• Heavy menstrual bleeding
• Chronic pelvic pain
• Uterine fibroids or tumors
• Uterine prolapse
• Enterocele causing discomfort or obstruction
• Patients who do not respond to medical management or other conservative treatment options

Preparation

• Fasting for at least 8 hours before surgery
• Adjustment or cessation of certain medications as advised by the doctor
• Preoperative blood tests, pelvic ultrasound, or MRI may be required
• Cleansing of the bowel with prescribed laxatives or enemas before the surgery

Procedure Description

1. Anesthesia: The patient is given general anesthesia or regional anesthesia (spinal or epidural).
2. Incision: A surgical incision is made in the vaginal wall.
3. Detachment: The uterus is carefully detached from the ligaments and blood vessels that hold it in place.
4. Removal: The uterus is then removed through the vaginal opening.
5. Enterocele Repair: The herniated segment of the small bowel is repositioned, and the defect in the vaginal wall is repaired.
6. Closure: The vaginal incision is closed with sutures.

Specialized surgical tools, such as retractors, clamps, and sutures, are used throughout the procedure.

Duration

The procedure typically takes about 2 to 3 hours, depending on the complexity.

Setting

The procedure is performed in a hospital operating room.

Personnel

• Surgeon (Gynecologist)
• Anesthesiologist
• Surgical Nurses
• Surgical Technicians

Risks and Complications

• Infection
• Bleeding
• Injury to surrounding organs (bladder, bowel)
• Blood clots
• Anesthetic complications
• Postoperative pain or discomfort
• Scar tissue formation and adhesions

Benefits

• Relief from heavy menstrual bleeding and pelvic pain
• Correction of the pelvic organ prolapse and enterocele
• Improved quality of life
• Permanent solution when compared to non-surgical treatments

Recovery

• Hospital stay of 1-2 days post-surgery
• Avoid heavy lifting and strenuous activities for 6-8 weeks
• Pain management with prescribed medications
• Follow-up appointments to monitor recovery
• Instructions on wound care and signs of infection to watch for

Alternatives

• Non-surgical treatments such as medication or hormonal therapy
• Other surgical options like laparoscopic hysterectomy or abdominal hysterectomy, each with different recovery times and risks
• Pelvic floor physical therapy for mild cases of prolapse

Patient Experience

During the procedure, the patient will be under anesthesia and will not feel pain. Postoperatively, some discomfort and pain can be expected, which will be managed with medications. Activities will be restricted for several weeks to ensure proper healing and recovery. Most patients experience significant relief from their previous symptoms and see improvement within weeks after surgery.