3 The procedure
3.1 Transvaginal mesh repair of anterior or posterior vaginal wall prolapse involves removing some of the stretched tissue if needed, and tightening the underlying tissue (colporrhaphy). Mesh is used to support the repair.
3.2 The procedure is usually done with the patient under general anaesthesia. Anterior colporrhaphy involves dissection of the vaginal mucosa through a midline incision in the anterior vaginal wall to expose the bladder and pubocervical fascia. The fascia is then plicated (folded), some excess tissue may be removed and the incision is closed. Posterior colporrhaphy involves a vaginal incision and plication of the levator ani. Other site-specific procedures, such as paravaginal repair, may also be done using methods similar to colporrhaphy.
3.3 The technique for inserting mesh varies. Mesh is usually placed using an open technique, although trocar introducers can also be used without direct visualisation. The mesh is usually positioned and sutured over the fascial defect as an 'inlay'.