Anterior vaginal wall repair using local anaesthesia

The purpose of the present study was to describe the possibility of surgical repair of anterior vaginal prolapse including amputation of the cervix using local anaesthesia. The description was made according to postoperative complication, recurrence rate, influence on urinary incontinence, and satisfaction of the patient.

Eighty-three women were consecutively operated in the anterior wall of the vagina using local anaesthesia and intravenously supplemented with propofol and fentanyl if needed, from January 1998 until September 2000 at a university clinic in Denmark. Operations executed by 16 different surgeons. Seventy patients were operated exclusively by anterior vaginal wall repair, 13 women were operated by other kinds of vaginal repair at the same time. All patients but one were interviewed by telephone. Ten patients reporting a sense of recurrence were called in for clinical examination.

The median age was 64.5 years (range 37-85). The median follow-up period was 12.5 months (range 3-35). Median time of the operation was 25 min (range 10-60) including all patients, 20 min (range 10-60) for the patients solely operated in the anterior vaginal wall. The median time spent in hospital was 1 day (range 0-4). One patient was readmitted. Seven patients (8.4%) suffered from complications postoperatively including the patient readmitted, four of these patients were reoperated. By interview 10 women (12%) reported symptoms of prolapse again. By examination two women (2.4%) were diagnosed as recurrence, and were offered a new operation using local anaesthesia. The incontinence patterns before and after the operation are described. Seventy-nine women (95.2%) were totally satisfied with the type of anaesthesia, two women would not choose local anaesthesia for an eventually new operation, one patient did not know, and one patient was unsolved.

The study illustrates an acceptable duration of the operation despite many different surgeons, a need of short time postoperative observation, low postoperative complication rate, low recurrence rate, and a high level of satisfaction reported by the patients. Surgical repair of anterior vaginal prolapse using local anaesthesia is described according to postoperative complication, recurrence rate, influence on urinary incontinence, and satisfaction of the patient. It is concluded that this way of handling anterior vaginal prolapse is suitable for all kinds of patients and in the out-patient clinic.