Background Vaginal looseness is a common problem in women. However, many procedures are based on the principle of narrowing the distal 1/3 of the vagina. We aimed to describe a new technique for tightening the vagina from top to bottom. Methods Forty-four parous women complaining of wide vaginas were operated on according to three supportive levels of the vagina: Level I is sutured by uterosacral and cardinal ligament attachments to the proximal 2–3 cm of the vagina. Level II restraint is supported by the vesicovaginal and rectovaginal fascia. The level III segment is the region 2–3 cm above the hymeneal ring and is reinforced with the perineal membrane. The circumferential submucosal 30 mm polyglactin sutures were passed through and tied at each level. Postoperative pain was assessed with visual analog scale (VAS) 24 h later. Anatomical results were evaluated via comparisons with preoperative values of the genital hiatus (GH), total vaginal length (TVL), and proximal/mid/distal vaginal width at the 6-month visit. The functional results were compared with the preoperative values of the Female Sexual Function Index (FSFI-6). Additionally, patients’ overall satisfaction was assessed with the Patient Global Impression of Improvement (PGI-I) questionnaire. Results The patients’ median age was 49 years (29–66 years). The mean duration of surgery was 38 min (31–56 min). The estimated blood loss was 35 ml (25–35 ml). No intraoperative complications were recorded. The mean VAS score was 2.7 (1.6–4.8). All patients stayed in the hospital for 1 night. A significant decrease in the dimensions of the vagina was noted (p < .05). There was no marked change in TVL (p = 0.53). When the preoperative total mean FSFI-6 score was 23.63 ± 6.84, it significantly increased to 27.11 ± 6.12, (p < .001). Thirty-seven of the 44 women (84%) responded “very much better” or “much better” on the PGI-I scale. Conclusions These findings support that Elçi technique is reliable for the treatment of vaginal laxity. It maintains normative dimensions of the vagina, with high FSFI-6 scores and patient satisfaction rates. Level of Evidence II This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors <a href="http://www.springer.com/00266">www.springer.com/00266</a>.

A Novel Surgical Approach for Vaginal Laxity: Tightening the Vagina from the Cervix to the Hymen; ‘‘Elçi Technique’’

期刊论文
发表日期：

2025年5月20日

查看全文

Adeviye Elçi Atilgan,
Ali Acar,
Asiye Uzun,
Emine Türen Demir,
Fatma Kiliç

摘要

Background

Vaginal looseness is a common problem in women. However, many procedures are based on the principle of narrowing the distal 1/3 of the vagina. We aimed to describe a new technique for tightening the vagina from top to bottom.

Methods

Forty-four parous women complaining of wide vaginas were operated on according to three supportive levels of the vagina: Level I is sutured by uterosacral and cardinal ligament attachments to the proximal 2–3 cm of the vagina. Level II restraint is supported by the vesicovaginal and rectovaginal fascia. The level III segment is the region 2–3 cm above the hymeneal ring and is reinforced with the perineal membrane. The circumferential submucosal 30 mm polyglactin sutures were passed through and tied at each level. Postoperative pain was assessed with visual analog scale (VAS) 24 h later. Anatomical results were evaluated via comparisons with preoperative values of the genital hiatus (GH), total vaginal length (TVL), and proximal/mid/distal vaginal width at the 6-month visit. The functional results were compared with the preoperative values of the Female Sexual Function Index (FSFI-6). Additionally, patients’ overall satisfaction was assessed with the Patient Global Impression of Improvement (PGI-I) questionnaire.

Results

The patients’ median age was 49 years (29–66 years). The mean duration of surgery was 38 min (31–56 min). The estimated blood loss was 35 ml (25–35 ml). No intraoperative complications were recorded. The mean VAS score was 2.7 (1.6–4.8). All patients stayed in the hospital for 1 night. A significant decrease in the dimensions of the vagina was noted (p < .05). There was no marked change in TVL (p = 0.53). When the preoperative total mean FSFI-6 score was 23.63 ± 6.84, it significantly increased to 27.11 ± 6.12, (p < .001). Thirty-seven of the 44 women (84%) responded “very much better” or “much better” on the PGI-I scale.

Conclusions

These findings support that Elçi technique is reliable for the treatment of vaginal laxity. It maintains normative dimensions of the vagina, with high FSFI-6 scores and patient satisfaction rates.

Level of Evidence II

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.