Vestibulectomy is a surgery that is associated with the excision of part of a vestibule located just above the urethral opening known as a “Urethral Meatus“.
The vestibulectomy is described as a surgical operation on the full left and right, anterior and posterior vestibule with an advanced flap in the vagina.
Vestibulectomy surgery is used to treat pain around the vulvar mostly for vestibulodynia cases. Vestibulodynia is a pain felt in the vestibule alongside an irritation close to the vagina. This painful tissue is removed.
This surgery is performed on women as the vestibule itself is located just a few centimeters left and right above the urethral opening.
In this case, the whole surgery revolves around the extraction of the whole hymenal tissues to the walls of the vestibules, down to the perineum.
Vestibulectomy is seen as a last alternative where the pain in the vestibules is untreatable.
For every surgical procedure, concepts and principles are guiding them to attain a successful operation. The composition of the vulva, urethra meatus, vestibule, and vagina are all separate therefore the skin on the vestibule and the pain fiber of high density can be removed or cut out.
Also, due to the connection of the anal mucosa of the anus, buccal mucosa of the mouth, and nasal mucosa of the nose to the skin in the anus, the vulva can be bonded effectively and carefully with the vaginal opening without any problem encountered.
WHY IS A VESTIBULECTOMY DONE?
Vestibulectomy surgery is done to remove hymenal tissues and vestibules that cause pain in the vestibules. Though the vestibulectomy is said to be the last resort, it is simple, time-effective, and less invasive.
ELIGIBILITY FOR VESTIBULECTOMY
Patients that must undergo the vestibulectomy surgery must have persisting symptoms for up to 6 months as a process known as spontaneous remission tends to occur over 6 months in the vestibulitis.
No special preparation is required to undergo the vestibulectomy, therefore, consulting the doctor for any other form of preparation is advisable before performing the vestibulectomy surgery.
The surgical procedure can be categorized into the procedure before the surgery, procedure during the surgery, and the procedure after the surgery.
Basically, before any surgical procedure, the patient is required to put on the hospital gown given for comfort and easy access to body parts. All valuable possession and jewelry are to be kept at home or placed in a secured location most likely by an accompanied partner.
Afterward, the patient is taken to a pre-operative room where the patient is laid down and the intravenous (IV) needle is inserted into the patient.
The patient with an accompanied partner or family member alongside the surgeon, anesthesiologist, recovery room nurse and operating room nurse, or any other surgical personnel meet for consent reasons where the risk, side effects, recovery, complications are discussed to obtain permission to carry on with the test.
The doctor then conducts series of tests and examinations to determine if the patient is eligible for the surgery in the pre-operation room.
Finally, the consent form is signed. Then, the patient is taken to the operation room either by the bed or walking, though to be moved by the bed, sedatives will be administered to the patient to relax the patient before transferring.
Getting to the operation room, the patient is placed on the operation table.
The patient is given regional or general anesthesia to numb all pains and calm the nerves by the surgical nurse present in the room and an anesthesiologist after which the patient is then fixed on a standard lithotomy position where the legs are strapped up while laying with the back.
The patient’s vulva, vagina, and vestibules are located and properly cleaned utilizing a povidone-iodine preparation but depending on the allergies of the patient, several substances can be used in the stead of this preparation.
Selected soap is used by the scrub technician and the surgeon in charge to wash hands properly to avoid infections on the patient, thereafter, a sterile glove, a hospital gown, and a surgeon mask are worn to commence the surgery.
A magnifying surgical loupe alongside a headlight with a large ray of light is worn for a proper view of the patient’s vaginal opening.
Sterile drapes which expose the perineum only are covered on the patient afterwards a proper sterilized surgical marking pen is utilized for outlining the incision points measured in centimeters just above the urethral opening on both sides to Hart’s line. The line is marked laterally to the edge of the posterior angle of the fourchette.
The surgical mapping extends to the hymen around the vaginal opening indicating the area to be operated on.
A pain controller and blood reduction medication are administered to the patient in the region where the cut is to be made. This medication is known as marcaine which is tagged with epinephrine.
A surgical retractor and specialized surgical hooks are used to split and hold the area of the incision.
The tissues of the vestibular are carefully removed taking note of the urethral meatus to prevent intrusion. Then proceeding to the left lateral vestibule comprising of Hart’s line and to the right lateral vestibule made up of the hymnal remnants.
Finally, the last dissection takes place from the posterior part of the hymenal remnant to the fourchette. A depth of 3mm is required so as not to invade any other part. Then the tissues are sent to the pathologist.
The patient is sutured and while doing this there is no excess bleeding. The bleeding that occurs is cleaned with saline and more local anesthesia is administered to further relax the patient.
Thereafter, an ointment said to be antibiotic is rubbed on the region the incision was performed, then, a gauze is positioned over the incision. The patient is removed from the straps and taken to the recovery room.
The patient is permitted to return home if she is stable but it is advisable to place ice on the incised area for some days and consistently take a sitz bath over a period till the swelling and the pains subside.
The patient might be immobilized over 2 weeks, therefore, medications like narcotic analgesia are prescribed. The recovery process might take up to 6 weeks through the suture line will be present.
RISKS INVOLVED IN VESTIBULECTOMY SURGERY
Certain risks and side effects of vestibulectomy surgery are listed below:
It can take 2 to 4 months for a full recovery but there is said to be a 93% satisfaction to all patients that undergo the surgery successfully.
During the time of recovery, you should abstain from alcohol and smoking to aid quick healing. Avoid sex during this time.
Keep your vagina clean and dry at all times to avoid infections. You may need to eat a lot of fruits that will aid in boosting your healing speed.
After surgery, you can return to work 1 to 2 weeks after. Avoid strenuous activities for the time being till you are fully recovered.
SPECIALIST FOR VESTIBULECTOMY
A surgeon performs the vestibulectomy surgery though, assisted by a team consisting of the anesthesiologist, recovery room nurse, and operating room nurse.
- Anal muscle weakness.
- Reduction of lubricant in the vagina.
What is the success rate of the vestibulectomy?
The success rate of the vestibulectomy ranges from 60%-90%, making most of the patients cured or respond to the treatments.
- What is the difference between a vestibulectomy and vulvodynia?
The vestibulectomy and vulvodynia are similar with disparities in the type of tissue removed. In the former case, the vestibules are removed while for the latter, the vulvar is infected and needs to be removed.
- What triggers the vulvodynia?
The exact cause of the vulvodynia can not be pinpointed but factors like infection or irritation can contribute to the vulvodynia?
- Is the fistulectomy process painful?
The vestibulectomy surgery is not painful as sedatives and local anesthesia are administered to the patient to numb the pains and calm the nerves.
- Does a patient bleed excessively during the surgery?
No, medication is known as marcaine, and epinephrine is given to the patient to minimize bleeding.