Week 12, 2 - Gynecological Surgery Flashcards
Causes and risk factors for
Pelvic Organ Prolapse (POP)
Pregnancy and childbirth Advancing age Obesity Surgery Constipation and repetitive straining Genetic factors Menopause and oestrogen deficiency
Are women with urinary incontinence likely to suffer faecal incontinence?
Women with urinary incontinence are also likely to
suffer from faecal incontinence and prolapse and
vice versa
Physio before POP repair surgery
Peri-operative physiotherapy is suggested to be
beneficial to maintain PFM strength before repair
PFM strength decreases following vaginal surgery
Reduced PFM strength is associated with recurrent
POP
Physio post POP surgery
Post-operative physiotherapy does improve PFM
strength, genital hiatus measurements and supports
a better chance or avoiding recurrence of POP
Anterior and posterior repairs
Paravaginal repair
Colporrhaphy +/- mesh
Perineorrhaphy
Ventral Rectopexy
Risks with uterosacral ligament suspension
Risk of ureteric kinking 1-11% Recurrent upper vaginal prolapse 10-15% Shortening of the vagina causing painful intercourse 1-5% Clot formation in the upper vagina in 5% Compatible risk for SSLS for anterior compartment failure
Most common surgical procedure for vault
prolapse
Sacrospinous Colpopexy (SSC or SSLS)
Success of Sacrospinous Colpopexy
80-90% anatomical success
Maximal fibrosis at 3/12
After effects of sacrospinous colopexy
Creamy white vaginal discharge until vaginal
stitches absorb
5-10% of women will have post-op buttock
pain that can be severe
Usually should resolve by 6 weeks?
Unilateral suspension can result in deviation of
vaginal canal to one side
Pre-disposition to ant
Type of surgery Sacrospinous colpopexy vs Sacrocolpopexy
Sacrospinous colpopexy:
Vaginal
Sacroplexy:
Laparoscopic or abdominal
Type of suspension Sacrospinous colpopexy vs Sacrocolpopexy
Sacrospinous colpopexy:
Uterine or vault
Sacroplexy:
Vault suspension
Type of sutures Sacrospinous colpopexy vs Sacrocolpopexy
Sacrospinous colpopexy:
Absorbable sutures
Sacroplexy:
Synthetic mesh along anterior and posterior wall to sacrum
Which is gold standard in POP repair surgery? Why?
Sacroplexy.
o Lower rate of vault prolapse o Longer presentation time for recurrence (11 vs 4.7/12) o Less dyspareunia o Less post-op SUI
What does hysteropexy involve?
Mesh is secured to the back of the uterus Mesh is then secured via the presacral ligament After the mesh is secured, the mesh is covered with the peritoneal skin using an absorbable suture. This prevents intestines ie bowel form looping around the mesh and cause a postoperative bowel obstruction.
What type of hysteropexy is more succesful?
Sacrospinous hysteropexy success rates 62-100%
Sacrohysteropexy success rates 91-100%
Benefits hysteropexy vs hysterectomy
Can conceive post operation
Paravaginal repair
Reattach detached lateral vaginal
fascia to its normal point of
insertion on the lateral side wall
Paravaginal repair complications
o Ureteric obstruction
o Haematoma
o Vaginal abscess
Colporrhaphy Anterior repair
‘Zipper line’ on front wall Fascial sutures absorb 4/52 to 5/12 depending on suture Maximal fibrosis at 3/12 Success rates 45-66% o Higher with normal Levator (62%) o Failure 65% at 6/52 post with avulsion
Colporrhaphy Posterior repair
‘Zipper line’ on back wall Fascial sutures absorb over 4/52 to 5/12 depending on suture Maximal fibrosis at 3/12 Success rates 97% at 12/12 Failure rate 25% at 3-4years De novo dyspareunia rates 4-16% with perineorraphy Combined Colpoperineorrhaphy
Ventral Rectopexy
Treatment of full thickness rectal prolapse, mucosal or interssusception
Anterior mobilisation of the rectum and fixation to the sacral promontory
No posterior resection and lateral ligaments remain intact
Recurrence 0-6%
Less rates of constipation and incontinence compared to resection-rectopexy
Low published rates of Dyspareunia and de novo constipation (<2%)
Anterior Delormes Procedure
Excision of redundant rectal mucosa
Mortality 0-4%
Recurrence 0-38%
Improvement in constipation 13-100%, incontinence 32-67%
Terms for ocmplications related to prosthesis:
Contraction =
Shrinkage
Terms for ocmplications related to prosthesis: Prominence =
Protrude beyond the surface
