PREOPERATIVE DIAGNOSIS: Pelvic organ prolapse.
POSTOPERATIVE DIAGNOSIS: Pelvic organ prolapse.
OPERATIONS PERFORMED:
1. Abdominal sacral colpopexy.
2. Anterior repair.
3. Posterior repair.
SURGEON: John Doe, MD
ANESTHESIA: General endotracheal.
OPERATIVE FINDINGS: Omental adhesions to the anterior abdominal wall, large bowel adhesion to vaginal cuff, grade 2 vaginal vault prolapse, grade 3 cystocele, grade 2 rectocele.
SPECIMENS: None.
TUBES: Foley.
URINE OUTPUT: 325 mL.
ESTIMATED BLOOD LOSS: 75 mL.
COMPLICATIONS: None.
POSTOPERATIVE CONDITION: Good in PACU.
DESCRIPTION OF OPERATION: The patient was taken to the operating room where general endotracheal anesthesia was induced for abdominal sacral colpopexy, anterior repair, and posterior repair. The patient was prepped and draped in the normal sterile fashion. The patient was placed in Allen stirrups. A midline incision was then made with the help of a scalpel. The incision was taken down to the rectus fascia, which was incised in the midline sharply. Subsequently, the rectus muscle was separated in the midline, and the peritoneal cavity was entered sharply. It was noted that there were omental adhesions down to abdominal wall. These were taken down with Metzenbaum scissors and the Bovie.
Subsequently, on further inspection, there was a large bowel adhesion to the vaginal cuff, and EEA sizer was placed in the vagina for visualization of the vaginal vault. The adhesion was then taken down with the help of Metzenbaum scissors. Subsequently, the bowel was packed. A Balfour retractor was placed and the sacrum was identified. The peritoneum over the sacrum was then incised to expose the longitudinal sacral ligament.
Subsequently, a 0 Ethibond suture was placed through the longitudinal sacral ligament. Hemostasis was then assured over the sacral promontory. Subsequently, the two ends of the Ethibond sutures were placed through a Gore-Tex mesh, and the suture was tied down to the sacrum, thus anchoring the mesh. Subsequently, two sutures of 0 Ethibond were placed laterally to the vaginal cuff, and those sutures were then passed through the Gore-Tex mesh so that the Gore-Tex mesh was attached to the vaginal vault. This was done on both sides.
Subsequently, a third suture was placed in the midline over the vaginal vault. Hemostasis was noted. At this point, the sponges, laps and retractor were removed, and the fascia was closed with 0 PDS suture. The subcutaneous tissue was approximated with 2-0 Vicryl suture, and the skin was closed with staples.
Attention was then turned to the anterior and posterior repair part of the procedure. It was noted at this point that the grade 3 cystocele was reduced to a grade 2 cystocele. Thus, an incision was made in the anterior vaginal mucosa. The incision was taken down to just below the mid urethral position since the patient had a previous TVT and there was concern about disrupting the previous TVT. The bladder was dissected off the anterior vaginal mucosa bilaterally. The pubovesical fascia was approximated in the midline with 0 Vicryl suture. Three such sutures were placed. Subsequently, the excess vaginal skin was trimmed, and the vaginal wall was closed with interrupted 2-0 Vicryl sutures.
Attention was then turned to the posterior repair part of the procedure. Two Allis clamps were placed at the introitus. An incision was then made between the two Allis clamps, and with the help of the Metzenbaum scissors, the posterior vaginal walls were separated from the rectum up to midway in the vagina. The rectovaginal fascia was separated from the vaginal mucosa on both sides. The rectovaginal fascia was approximated in the midline with 0 Vicryl sutures. Four such sutures were placed. The excess vaginal skin was removed, and the vaginal skin was approximated with 2-0 interrupted sutures. At the introitus, a running suture of 3-0 Vicryl was placed and closed in a subcutaneous fashion.
At the end of the procedure, the Foley catheter was placed, and the vagina was packed. Sponge and needle counts were correct. The patient tolerated the procedure well.
