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abdominal vs. vaginal repair abdominal vs. vaginal repair

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Unread 03-21-2005, 06:21 PM
abdominal vs. vaginal repair

I have posted about this before, and have asked individual people what they felt about this, but I think its important (for my mental state) to put it "out there" and get as many responses as possible....so here goes...........

I had a d & C on Nov 8, 2004 that went "bad"...I had to go back to the emergency room that day because there was a perforation. Turns out my gyno perferated my uterus and my lower bowel............ I went in for an emergency hysterectomy and a quick fix of the lower bowel. at which time, my gyno nicked my bladder. I was bleeding so badly and was in such trouble, that the urologist closed me "before being able to put fatty tissue inbetween the vagina and bladder.....ie....6 weeks later i had a confirmed fistula.

I had opted for a vaginal repair of the fistula on January 18, 2005(being told it was the size of an eraser on a pencil) with hopeful results. Turns out there was probably an infection (which wasnt detected until to late) and the repair failed.........after 5 weeks.

I am now trying to decide whether or not to go back and try a vaginal repair i am scheduled for surgury april 12, 2005(putting fatty tissue from my labia and checking weekly for infection...those 2 things being different from the 1st time) or do I just bite the bullet and do it abdominally and for the last time. I am being talked into trying it vaginally for the 2nd time because "what have i got to lose" and because its so much less invasive....but what nobody is considering is my mental well being! I cant take another "failed" try...mentally I think it will put me over the edge not to mention the "no sex" rule since early novemeber....how much should the dh have to put up with?????? or how much should i?

thank you all for allowing me to vent, i am hoping to get some insight into how to go about making this decision....only those who have been there before, can really help...so, please, anyone with an opinion, I would greatly appreciate your insight.......

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Unread 03-21-2005, 06:42 PM
abdominal vs. vaginal repair


I do understand your dilemma. I really wanted my uro to just do the abdominal repair to begin with for my first repair. He said once he got in there he would decide if a vaginal repair would work or not. He was just so sure he had it fixed, but no such luck. Not knowing what kind of surgery I was going to have was terrible, not that I had to plan anything differently, just not knowing was emotionally draining.

For the abdominal repair, I will tell you it was a much harder surgery physically than the vaginal repair, but the success rate is much higher...but of course all of that depends on where the fistula is, and how big it is, etc.

Do you still have an infection now? I also had an infection with Repair #1. My doc said he would operate whether or not I had an infection at the time. Turns out that was not such a good idea. Repair #2 got canceled at the last minute because of an infection. I ended up taking 10 days of Cipro and 10 days of diflucan just before the surgery to make sure everything was cleaned up.

It is a hard decision to make, but I am glad that my 2nd repair was abdominal. My uro said they could see better what was going on in there. And, as it turned out, there was a lot going on in there...adhesions, and my bladder was stuck to just about everything, so they were able to get all that cleared up at the same time. I am convinced I would have needed another surgery after the fistula repair to clean up the adhesion mess, had it been a vaginal repair again.

And the no sex thing...my DH and I could not have sex for just short of a year between massive bleeding problems before the hyst, and the two repairs. He survived. In fact, maybe he appreciates it (and me) more!!

So, if you want my honest opinion, I would vote for abdominal repair. I had a vertical incision, and they used omentum to separate the bladder from the vagina (four layers I am told). But, please do what you feel is right for you after talking with your doctor.

HUGE s to you!!

Unread 03-21-2005, 06:52 PM
abdominal vs. vaginal repair

Thank you Dee..

You have been an inspiration...that you have found success is the best inspiration one could ask for....but I appreciate your honest reaction to whether or not to do it abdominally. My gut reaction is what you said, to go ahead and have a successful repair abdominally and to have them fix all the possible mishaps that went on during my emergency surgury..I am already feeling pain (i think) from adhesions due to the last surgury. I think maybe they can clean up from the last surgery and clearly fix the obvious problem...

So thank you in advance for your honesty. I am meeting with the surgeon tommorrow. he is the one that works with my urogynocologist. I will post again after I decide which way to go?

thank you
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Unread 03-21-2005, 07:00 PM
abdominal surgery vs vaginal

I just logged on to try to find answers to my own problems when I saw your horror story. I had similar problems and opted for the abdominal operation by a urogynacologist at a hospital in Phila. It is so important to have a doctor who has this degree. The operation is not so bad. I do not know your age. I am an older women and had to think long and hard about it. Decided to do it while I was in good health . Had to pass stress test etc.
The first six weeks were hard, but they passed. My surgery was Nov.23. It is now four months and I still feel "pressure" as if the bladder has slipped a little. Not sure if I am just nervous and dwelling on this part of my body. I have been back to my normal life being a care giver etc. At least nothing is "hanging" out. The name of the operation is sacrocolpoxy. Feel free to write back. Hope I helped some. It may be better to bite the bullet and get it all done abdominally so the doc can get in there and see how things look. I had so much scar tissue etc. Do not regeret my decision, even though I may know have a small problem. Good luck!
Unread 03-21-2005, 07:08 PM
abdominal vs. vaginal repair


Thank you for your response. I have never heard of sacrocolpoxy. Is that related to a fistula? I have not heard of that yet, but I will look it up. I am 44 years old and I was in great health prior to this nightmare....I recovered rather quickly from the emergency hysterectomy, even though I had lost alot of blood and was in "trouble" from the complications. I believe, more and more from everyones responses, that I would be better off going the abdominal route. That will ensure that everything is done correctly and although its invasive, at least its successful.

Thanks for your email...I will continue to keep you posted,
Unread 03-21-2005, 07:37 PM


Look it up on the web. I think is is spelled sacrocolopexy They placed mesh on the bottom of my pelvis and tied my bladder and rectum up to the mesh. The mesh was anchored to my spine. Did not feel any after effects from the mesh.
Keep in touch and hope that I can help in any small way.
Unread 03-22-2005, 05:47 PM
abdominal vs. vaginal repair

Hi Nancy,

By now you may have seen your Surgeon and made your decision but I just thought I would pop in anyway.

It appears I had the same scenario as Dee, a failed vaginal repair followed by successful abdominal repair with vertical incision using the omentum. Like Dee I am glad I went for the abdo route. The Uro said there was a lot of scar tissue on the bladder after the vaginal repair and that the bladder was "badly damaged". At that stage I was having difficulty emptying my bladder due to the scar tissue and this has now been resolved. I am sure another vaginal repair would not have been able to repair the bladder as effectively.

There seems to be 2 schools of thought: a Gyn will always prefer to operate vaginally. A Uro is an abdominal surgeon. So obviously it is going to depend on who you talk to. But my Uro said the only way to guarantee success was abdominally. Personally I didn't find the operation as bad as the hyst!

Which ever way you choose to go, make sure whoever does it has a LOT of experience in that particular operation. He/she needs to be able to guarantee a success story.

Good luck! And keep us posted on your decision.
Unread 03-22-2005, 06:05 PM
abdominal vs. vaginal repair

Thanks blossom, for your information and your insight...

I did see the Urologist, and just like my urogynocologist, he suggested I try the vaginal way again using fat from my labia to secure the repair...they didnt do that the first time....he felt, that the abdominal approach should only be used as the last resort...and I am sooo confused.....

He did admit that fortunatly for him (unfortunatly for me) he doesn't see this very often....its so rare....but he did say that he would go transvaginally before abdominally, if infact, the layer of fat is used.........ughhhhhhhhhhh its so GREY....I am usually a black or white kinda person, I usually have a strong gut too...and none of that is working for me this time????????????//

I am finding it hard to find a urologist or an urogynocologist in my area (the major washington, dc area) who has seen and /or done alot of this kind of surgery....so what is one to do???????????????????

I appreciate all the help, the responses, and the info.....

Unread 03-22-2005, 06:31 PM
sacrocolopexy rectocele/cystocele

I am not sure if I am reading your post correctly or not. Are you saying that you can not find a urogynacologist in your area? If so, you are near one of the biggest Hospitals in the USA. John Hopkins.
Bring up their web site and look for one. I took my DH there from South Jersey.
I only found mine by doing a lot of research and looking at the staff on each hospital in Phila. I had three opinions before I settled on the abdominal approach.
Wish you luck. I do know what you are going through!!!!

Write if I can help you with any more info.

Unread 03-22-2005, 07:09 PM
abdominal vs. vaginal repair


No, I have found a urogynocologist at WAshington Hospital Center, in DC...who I believe is very good...but I am starting to doubt my gut reaction....

I looked into Johns Hopkins, and spoke to a uro/oncologist there that wasnt to sympathetic ......so I hate to switch now....

You had the abdominal repair also? was that after a failed vaginal approach...I am sorry, but I am losing track of everyones situation...i guess i am a bit overwhelmed....

how was your recovery of your abdominal repair? is it as bad as my dr is painting the picture? what was the worst part for you?

thanks for your reply, I cant tell you how much you all have helped me thru this awful situation!

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