Old cervical rupture
Cervical ruptures during childbirth are common, but are not always repaired promptly and correctly. The remaining defect leads to deformation of the cervix, gaping of the cervical canal and constant contact of the mucous membrane of the canal with the contents of the vagina. The consequences are chronic cervicitis, ectropion (eversion of the mucous membrane), recurrent inflammation and, most importantly, isthmic-cervical insufficiency with the risk of miscarriage in the next pregnancy. Emmett's operation excises the scarred edges of the tear and restores the anatomical shape of the neck. It should be planned before the next pregnancy, and not during it.
When is reconstructive surgery needed?
Childbirth, especially with perineal ruptures and a large fetus, and age-related changes lead to stretching and damage to the muscles and ligaments of the pelvic floor. Prolapse of the walls of the vagina, uterus and bladder develops, a feeling of a foreign body, urinary incontinence, impaired bowel movements and discomfort in sexual life appear.
Conservative methods - Kegel exercises, pessaries - are effective in the early stages. In case of pronounced prolapse and formed defects, the anatomy can only be restored surgically.
Principles of reconstruction
- restoration of anatomy using the patient’s own tissues
- bringing the levator muscles together to form support for the pelvic floor
- excision of scar tissue that is unable to bear the load
- if necessary, a combination of several stages in one operation
Recovery
The key condition for success is adherence to the regime: sexual rest for 6–8 weeks, avoiding heavy lifting and preventing constipation. An increase in intra-abdominal pressure in the early period is the main cause of suture dehiscence and relapse of prolapse.