Vaginal tightening surgery by strengthening the pelvic floor support / 中华医学美学美容杂志

Objective To explore the related pelvic floor anatomy to the pathological vaginal relaxation and key points of the vaginal tightening surgery.Methods The vaginal tightening surgery was performed in 24 cases of vaginal relaxation.The key points of this operation included levator ani muscle suturation and perineal body reconstruction,and anal sphincter reconstruction as in case of the muscle injury grade Ⅲ.Results The degree of levator ani muscle separation was positively correlated with that of vaginal relaxation in all the 24 cases.18 cases were followed up from 6 months to 2 years,and had no complications of rectovaginal fistula and infections.The average level of perineal body was increased from 2.3 cm to 3.5 cm.Vaginal length of 6 cm from vaginal orifice was proper with good tightness.The patients felt strong anal contraction,enhanced ability of vaginal tightening and improved quality of sex life.There were no more infections of genitourinary tract.Conclusions Through levator ani muscle suturation and perineal body reconstruction,it can get the vaginal tightening effect.

Repair of Rectovaginal Fistulas

Thirteen women with rectovaginal fistulas unrelated to inflammatory bowel disease or previous radiotherapy were operated on during Jan. 1993 - Jul. 1997 at Song-Do Colorectal Hospital. The mean age was 36.9 (range, 25~56) years. The mean follow-up after operation was 33 (range, 8~62) months. The etiology of the fistula in the majority of patients was obstetric injury and operative trauma (10/13). Seven patients were referred after attempts at repair elsewhere. Eleven patients were managed with a mucosal flap advancement and a 3-layered repair of the rectovaginal septum: 4 without and 7 with a perineal body reconstruction or sphincter repair. Two patients were managed with a mucosal flap advancement only without a repair of rectovaginal septum. In all cases, a concomitant colostomy was not performed. Postoperative complications were noticed in 3 of the patients managed by a mucosal flap advancement and 3-layered repair of the rectovaginal septum with perineal body reconstruction or sphincter repair and all were perineal wound infections. All of these infections were cured, without recurrence, by simple rubber seton drainage. Recurrence occurred in one case managed by a mucosal flap advancement only. Three patients with liquid incontinence became continent after a sphincter reconstruction. We conclude that most rectovaginal fistulas unrelated to inflammatory bowel disease or previous radiotherapy can be managed with a mucosal flap advancement and 3-layered reconstruction of the rectovaginal septum. If any signs or symptoms of sphincter injury are noticed preoperatively while taking the patient's history or during manometry and endorectal ultrasonography, a perineal body reconstruction or sphincter repair should be performed.