A wide local excision is a surgical procedure to remove a specific area of abnormal tissue (e.g., a lesion, tumour, or precancerous cells) from the vulva (external genitalia), along with a margin of healthy surrounding tissue. It is less extensive than a full vulvectomy and aims to preserve as much healthy tissue as possible.
Why is it done?
- To treat early-stage vulvar cancer or precancerous changes (Vulvar Intraepithelial Neoplasia, VIN).
- To remove benign growths, severe infections, or chronic skin conditions that do not respond to other treatments.
Preparing for Surgery
- Pre-op Tests: Biopsies, blood tests, or imaging may be done to plan the surgery.
- Medications: Discuss current medications (e.g., blood thinners) with your doctor. You may need to stop some temporarily.
- Fasting: No food or drink for 6–8 hours before surgery, as directed.
- Support: Arrange help at home for the first few days of recovery.
During the Procedure
- Anaesthesia: Usually performed under local anaesthesia with sedation or general anaesthesia.
- Duration: Typically, 30–90 minutes, depending on the size and location of the tissue removed.
- Procedure: The surgeon removes the abnormal tissue and a small margin of healthy tissue around it. Stitches (sutures) are used to close the wound.
- Questions: Address any concerns about scarring, recovery, or sexual health with your care team.
Recovery After Surgery
Immediate Post-Op Care:
- Hospital Stay: Often done as an outpatient procedure (go home the same day), but some may stay overnight.
- Pain Management: Mild to moderate pain is common. Prescribed painkillers or over-the-counter medications (e.g., acetaminophen) can help.
- Wound Care:
- Keep the area clean and dry.
- Use gentle cleansing with water or a recommended solution.
- Avoid baths, swimming, or soaking the area until healed.
- Wear loose, breathable clothing to reduce irritation.
Activity Restrictions:
- Avoid heavy lifting, vigorous exercise, or sexual activity for 2–4 weeks (or as advised).
- Driving may be restricted for 1–2 weeks, especially if on pain medications.
Long-Term Considerations
- Scarring: Some scarring is normal, but it usually fades over time.
- Sensation: Temporary numbness or tenderness near the surgical site may occur.
- Sexual Health: Most patients resume normal sexual activity after healing. Discuss any concerns (e.g., discomfort) with your healthcare team.
- Follow-Up: Regular check-ups to monitor healing and ensure no recurrence of abnormal cells.
6. Frequently Asked Questions (FAQs)
Q: How soon can I return to work?
A: If your job is not physically demanding, you may return in 1–2 weeks. For active jobs, wait 2–4 weeks.
Q: Will this affect my ability to have children?
A: This procedure does not affect fertility or the internal reproductive organs.
Q: What if the results show cancer?
A: Further treatment (e.g., additional surgery, radiation) may be recommended. Your care team will guide you.
Q: Is recurrence possible?
A: Regular follow-ups help detect any new changes early. Protect vulvar skin (e.g., avoid irritants) to reduce risks.
eGynaecologist Advice:
- You should seek counselling services to discuss emotional/sexual health concerns with your gynaecological team if you are going to undergo wide local excision of vulva.
- You should seek gynaecological consultation if you develop signs of infection: Redness, swelling, pus, raised temperature >38°C, or worsening pain.
You must seek gynaecological consultation if you have difficulty urinating or severe discomfort after wide local excision.
