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 (Vulval 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 day case 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., paracetamol) 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.
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.
Frequently Asked Questions
How soon can I return to work?
If your job is not physically demanding, you may return in 1–2 weeks. For active jobs, wait 2–4 weeks.
Will this affect my ability to have children?
This procedure does not affect fertility or the internal reproductive organs.
What if the results show cancer?
Further treatment (e.g., additional surgery, radiation) may be recommended. Your care team will guide you.
Is recurrence possible?
Regular follow-ups help detect any new changes early. Protect vulval skin (e.g., avoid irritants) to reduce risks.
