Vaginal Reconstructive surgery: What surgical footprint to leave behind.

"No man ever steps in the same river twice, for it's not the same river and he's not the same man." (Heraclitus)

In the revolution of Vaginal Reconstructive Surgery new techniques come and go. The basic choices are to either stay with the known "classical" anterior colporrhaphy- with all its known defects and ethical issues- or to implant synthetic meshes between the bladder and the vaginal cavity.

To the author both these surgical footprints are not acceptable. On the one hand destructive surgery is the basis of the quest to rid the patient of her bulge with the classical operation,while on the other hand own experience showed that the implanting of a synthetic mesh (n=70) between two cavities leads to shrinkage in 100% of cases after 12 months, with resultant risks of support failure, and even more important, erosions and dyspareunia.

Both these techniques are a disgrace to our profession and can not be condemned in strong enough terms!

There is an alternative footprint: reconstructing the damaged anatomy to as near as possible to the original state, without doing your patient harm. To induce the body to reconstruct its own weakened collagen is the ultimate goal of reconstructive surgery.

With this one leave a surgical footprint behind which follows the rule of do no harm- a footprint that can be a foundation to build on if the result of the surgery is suboptimal: this is the basis of the future of vaginal organ reconstructive surgery.

In the following chapters the author is going to allow the reader to enters his world of pelvic organ reconstructive surgery.

For interested Vaginal Reconstructive Surgeons the following DVD's are available on visiting the unit at Terneuzen:

1. Primary Vaginal Sidewall Specific Repair (VSSR)

2. Suboptimal Results: Removal of Anterior Prolift

3. Suboptimal Results: VSSR after previous Classical Repair

4. Suboptimal Results: Vaginal Hysterectomy and vaginal Topplasty after previous VSSR and Post Prolift.

5. Suboptimal results after Ant Post Prolift: Vaginoplasty.