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

backgroundVaginal 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.

methodsForty-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.

resultsThe 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.

conclusionsThese 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 .