Anterior and Posterior Repair (Colporrhaphy)

An anterior and posterior repair (anterior and posterior colporrhaphy, or "A and P repair") fixes two kinds of vaginal prolapse in one operation. A cystocele is the bladder bulging into the front wall of the vagina. It can cause pressure, a bulge at the vaginal opening, trouble emptying the bladder or stress incontinence. A rectocele is the rectum bulging into the back wall of the vagina. It can cause a bulge, pressure and difficulty passing stool. An enterocele, a small hernia of bowel through the top of the vagina, may be present too. Childbirth is the most common cause; aging, an inherited weakness or past surgery can also play a part. The whole operation is done through the vagina, with no abdominal incision. The anterior repair opens the front wall, frees the bladder and gathers the fascia beneath it with plication stitches, sometimes with a Kelly stitch at the bladder neck for incontinence. The posterior repair opens the back wall, frees the rectum, closes the fascia over it, may bring the levator muscles together, and usually rebuilds the perineum (perineorrhaphy). Either repair can be done alone, and both are often added to a vaginal hysterectomy. Current evidence does not support using mesh through the vagina for rectocele repair. For the scrub, this is a vaginal-tray case done with the patient in lithotomy and the surgeon seated. It uses many Allis and Allis-Adair clamps and long rows of plication sutures. The anterior half is finished, the instruments are reset, and the same pattern is repeated on the back wall. Possible complications are bleeding or hematoma, urinary retention or infection, a narrowed or shortened vagina, painful intercourse, injury to the bladder or rectum, and the bulge coming back.