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Posterior Repair & Hysterectomy Posterior Repair & Hysterectomy

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Unread 04-08-2005, 11:46 AM
Posterior Repair & Hysterectomy

Posterior Repair & Hysterectomy

I am having a vaginal hysterectomy and bladder lift in May for a prolapse and I also have had a failed anal-sphincter repair.

My colorectal specialist has advised my gynaecological surgeon not to proceed with posterior repair to the vaginal wall as it may make the faecal incontinence worse.

My worry is how will the pelvic floor be supported after the hysterectomy if the posterior repair is not done as I have read that vaginal prolapse can be worse after a hysterectomy.

Has anyone else been in this situation i.e. hysterectomy without posterior repair for colorectal reasons?

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Unread 04-08-2005, 01:49 PM
Posterior Repair & Hysterectomy

Just asking I have never heard of this but wonder if resuspending the uterus is ever done, thus avoiding hysterectomy and any further nerve damage.

If this is not an option then what about retaining the cervix as a way of sparing blood and nerve supply in the area?

Best of luck to finding a good solution to your problem.
Unread 04-08-2005, 06:50 PM
Posterior Repair & Hysterectomy

Hi (((Margaret))) Boy, I have not heard that one. I had a TVH, A&P repairs and bladder lift 3 years ago and don't have any problems with fecal incontinence. Did your DR explain why this would happen and cite any statistics about how often it happens, if at all?

What does your colorectal surgeon propose to do to minimize the possibility of a rectocele post hyst? We have a number of ladies here who have experienced a rectocele post hyst and ended up having to have posterior repair surgery later. JMHO, but I'd want to get it done all at once if you know you're going to be predisposed to it.

Regarding the non hyst option... for situations of severe prolapse, resuspending the uterus is rarely successful for longer than a few years. Unfortunately, that uterus is heavy, and gravity tends to want to let it fall into the vagina... the hormone changes of menopause (whether natural or surgical) hasten the process by loosening the pelvic ligaments (even if they've been shortened through a resuspension procedure).

I wonder if another opinion might be in order?

Good luck with your surgery!
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Unread 04-09-2005, 03:51 AM
Posterior Repair and Hysterectomy

Dear Linda,

Thank you for your reply.

It was very helpful. I already have a rectocele (as well as enterocele, cystocele)and a failed anal sphincter repair.

The colorectal surgeon has written to the gynaecological surgeon saying to go ahead with the hysterectomy bladder lift and modified Mc Cull culpoplasty but to avoid the posterior repair as "it may have a detrimental effect on her ano rectal function".

What concerns me is the risk of further prolapse post hysterectomy if the posterior wall is not done. The colorectal surgeon is proposing Sacral Nerve Stimulation for the rectal problem after I have my hysterectomy.

Maybe he is afraid of damage to the sacral nerves if the posterior repair were done first? The thing is that I have not seen the colorectal surgeon since Dec nor the Gynae. surgeon since January10th despite requests from my GP that he see me so I sit here and worry about the risk of good outcome to this operation on the 16th May!

PS I don't understand FMHO in your message but thanks again for taking the trouble to respond.

With kind regards,

Unread 04-09-2005, 12:58 PM
Posterior Repair & Hysterectomy

Oops! Sorry about that (((Margaret))), JMHO just means "just my humble opinion" In other words, I'm not an MD, just relating my own experience, which might be like yours or might not.

I'd feel very uncomfortable about going into surgery with this issue unresolved and not having been seen by these surgeons again and having heard them voice some sort of agreement about what needs to be done and what is best for your outcome. I'd insist on seeing them - for your peace of mind if nothing else.

Unread 04-09-2005, 01:14 PM
Posterior Repair & Hysterectomy

Dear Margaret:

I also had TVH for prolapse. My 2nd medical opinion said: "any gyn can do this surgery" which freaked me out a bit, so I found my 3rd medical opinion (and eventual surgeon), who was a uro-gynecologist specializing in pelvic reconstruction.

Here is a link to the prolapse section of our Resources Directory:

I think it's imperative that you feel comfortable with your choice of treatment before you proceed with the surgery. Ultimately YOU are the one who has to live with the outcome of the surgery, good OR bad.

I am sending huge cyberhugs

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