Anesthesia in genital prolapse surgery

This is an automatically translated article.

The article was professionally consulted by Specialist Doctor I Nguyen Xuan Tinh - Anesthesiologist - Resuscitation - Department of General Surgery - Vinmec Phu Quoc International General Hospital. Doctor Nguyen Xuan Tinh has more than 18 years of experience studying and working in the field of Anesthesia - Resuscitation.
Genital prolapse is a phenomenon in which the uterus is lowered into the vagina or completely outside the vulva, often accompanied by prolapse of the anterior vaginal wall and bladder or the posterior wall of the vagina and rectum.

1. Causes of genital prolapse

Multiple births, thick births, unsafe delivery techniques during childbirth, perineal tearing without stitches. Heavy labor or labor soon after giving birth increases abdominal pressure, pressing on the soft perineum easily causes genital prolapse. Causes of frequent increase in abdominal pressure: Carrying, carrying heavy burdens, chronic constipation, prolonged cough, street vendors often sitting on the roadside... Nutritional disorders in the elderly , the suspension and support system of the uterus is weakened. In addition, it may be due to congenital anomalies in people who have never given birth.

2. Signs of genital prolapse

Common symptoms are discomfort, heaviness in the lower abdomen, frequent urination, urinary incontinence, urinary incontinence, sometimes difficult defecation.
When going to the doctor, the prolapsed mass is located in the lower 1/2 of the vagina or protruding the vulva, the most severe case will prolapse outside the vulva. The prolapsed mass may be keratinized or ulcerated by rubbing or superinfection.
Genital prolapse is divided into 3 levels. In which, 3rd degree genital prolapse is the most severe level, the uterus prolapses completely outside the vulva.

3. Anesthesia method in genital prolapse surgery

The patient was under general anesthesia during surgery for genital prolapse. Local anesthetic. The performer is a specialist doctor, a nurse to support.
There are many surgical methods of genital prolapse. But now there are three commonly chosen methods:
3.1 Manchester method The Manchester method is indicated mainly for women who are young, want to have children and have second degree. This surgery is also applicable to elderly patients with grade III genital prolapse who cannot tolerate major surgery.
The main surgical steps of this procedure:
Cervical amputation Shortening of the Mackenrodt ligament Suture of bladder lift Reconstruction of the anterior wall Restoration of the cervix with Sturmdorft stitches Reconstruction of the posterior vaginal wall. 3.2 Crossen method Indicated for patients with grade III genital prolapse. Crossen surgery is performed only when the cervix is ​​not ulcerated. Total hysterectomy is done vaginally. Cross tie the Mackenrodt ligaments and the other round ligaments to suspend the sutures into a strong hammock, preventing prolapse of the intestines Suture of the bladder Elevation of the bladder Reconstruction of the anterior wall. Suture the levator anal muscle, redo the posterior vaginal wall. 3.3 Lefort method Lefort method is a simple method applied to the elderly, no longer having sexual intercourse, vagina, and cervix are not infected. Technique: Vaginal closure In addition, one can only do Vaginal anterior wall reconstruction, bladder lift, or posterior vaginal wall reconstruction and rectal lift If this is used in women who still have a uterus, it is necessary to leave two small slits in the vagina to allow drainage of the uterine fluid out. If the whole suture is closed, it can cause an abscess of the uterus and pelvis. 3.4 Prevention of genital prolapse Genital prolapse is a rare disease that is life-threatening, but it causes many inconveniences in life and significantly reduces the patient's quality of life. But women can avoid it by following these precautions:

Do not lay much, lay prematurely, lay too thick. It is advisable to give birth at a maternity home or a qualified medical facility to ensure the health and safety of both mother and child. Having the right delivery technique, Do not let the labor time prolong, do not push for too long. Performing the procedures must ensure sufficient conditions, correct indications and correct techniques. Genital tract injuries must be repaired with proper technique. After giving birth, you should not work too early and do too much. Avoid constipation. It is necessary to detect and treat early chronic diseases that cause frequent increase in abdominal pressure such as long-term constipation, prolonged cough... Because this is the cause of genital prolapse.

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