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Women's Health > Week 12, 2 - Gynecological Surgery > Flashcards

Week 12, 2 - Gynecological Surgery Flashcards

1
Q

Causes and risk factors for

Pelvic Organ Prolapse (POP)

A 
 Pregnancy and childbirth
 Advancing age
 Obesity
 Surgery
 Constipation and repetitive straining
 Genetic factors
 Menopause and oestrogen deficiency
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2
Q

Are women with urinary incontinence likely to suffer faecal incontinence?

A

 Women with urinary incontinence are also likely to
suffer from faecal incontinence and prolapse and
vice versa

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3
Q

Physio before POP repair surgery

A

 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

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4
Q

Physio post POP surgery

A

 Post-operative physiotherapy does improve PFM
strength, genital hiatus measurements and supports
a better chance or avoiding recurrence of POP

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5
Q

 Anterior and posterior repairs

A

 Paravaginal repair
 Colporrhaphy +/- mesh
 Perineorrhaphy
 Ventral Rectopexy

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6
Q

Risks with uterosacral ligament suspension

A 
 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
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7
Q

Most common surgical procedure for vault

prolapse

A

Sacrospinous Colpopexy (SSC or SSLS)

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8
Q

Success of Sacrospinous Colpopexy

A

 80-90% anatomical success

 Maximal fibrosis at 3/12

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9
Q

After effects of sacrospinous colopexy

A

 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

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10
Q

Type of surgery Sacrospinous colpopexy vs Sacrocolpopexy

A

Sacrospinous colpopexy:
Vaginal

Sacroplexy:
Laparoscopic or abdominal

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11
Q

Type of suspension Sacrospinous colpopexy vs Sacrocolpopexy

A

Sacrospinous colpopexy:
Uterine or vault

Sacroplexy:
Vault suspension

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12
Q

Type of sutures Sacrospinous colpopexy vs Sacrocolpopexy

A

Sacrospinous colpopexy:
Absorbable sutures

Sacroplexy:
Synthetic mesh along anterior and posterior wall to sacrum

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13
Q

Which is gold standard in POP repair surgery? Why?

A

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
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14
Q

What does hysteropexy involve?

A 
 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.
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15
Q

What type of hysteropexy is more succesful?

A

 Sacrospinous hysteropexy success rates 62-100%

 Sacrohysteropexy success rates 91-100%

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16
Q

Benefits hysteropexy vs hysterectomy

A

Can conceive post operation

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17
Q

Paravaginal repair

A

 Reattach detached lateral vaginal
fascia to its normal point of
insertion on the lateral side wall

18
Q

Paravaginal repair complications

A

o Ureteric obstruction
o Haematoma
o Vaginal abscess

19
Q

Colporrhaphy Anterior repair

A 
‘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
20
Q

Colporrhaphy Posterior repair

A 
‘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
21
Q

Ventral Rectopexy

A

 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%)

22
Q

Anterior Delormes Procedure

A

 Excision of redundant rectal mucosa
 Mortality 0-4%
 Recurrence 0-38%
 Improvement in constipation 13-100%, incontinence 32-67%

23
Q

Terms for ocmplications related to prosthesis:

Contraction =

A

Shrinkage

24
Q

Terms for ocmplications related to prosthesis: Prominence =

A

Protrude beyond the surface

25
Q

Terms for ocmplications related to prosthesis: Separation =

A

Physically disconnected epithelium

26
Q

Terms for ocmplications related to prosthesis: Exposure =

A

Mesh visible through epithelium

27
Q

Terms for ocmplications related to prosthesis: Extrusion

A

Tape proturding into vaginal cavity

28
Q

Burch colposuspension

A

Stress incontinence surgery - bladder elevation theory.

Reposition bladder neck and urethra to a high retropubic position. Has one of best long-term results.

Does not allow for correction of central defect cystocele, rectocele or introital deficiency.

29
Q

Theories for stress incontinence surgery

A

Bladder elevation

Backstop theory

30
Q

Backstop theory stress incontinence surgeries

A

++Retropubic

  • TVT
  • Sparc

++Trans Obturator

  • TVT-O
  • Monarc

++Minislings
- TVT-Secur

 Slings = MESH
 Not sutured but have mini-hooks that act like velcro to stay in place

31
Q

Complications retropubic incontinence surgeries

A

 Bladder perforation and voiding dysfunction more common in retropubic

32
Q

Complications obturator incontinence surgeries

A

Neurologic symptoms (leg weakness) greater in obturator (9.4% vs 4%)

33
Q

 Most common Gynaecological

procedure in the world =

A

Hysterectomy

34
Q

Different Approaches Hysterectomy

A

– vaginal, LAVH

and abdominal

35
Q

Total hysterectomy =

A

Total = uterus and cervix

36
Q

Radical hysterctomy

A

uterus, cervix, top of
vagina, ovaries, fallopian tubes,
lymph nodes and tissue around cervix

37
Q

Manchester repair = (and risk)

A

remove cervix,
keep uterus. High likelihood of
enterocele

38
Q

Vulval excisions

A 
Early intraepithelial neoplasias of the
vulva frequently have multicentric foci of
disease
 Incision closed by mobilising the skin
lateral to the incision and creating a
relaxing incision at an appropriate place
to allow coverage of the vulvar defect
 Can involve skin or fat grafting
39
Q

Vulvectomy

A

 Vulvectomy is indicated for severe lesions
of the vulva that are not amenable to
local excision or other forms of
conservative therapy

40
Q

Physiotherapy Management

Acute care gynae surgery

A

Early mobilisation has been considered the first line
prevention of post-operative pulmonary complications (PPC)
since 1976
 Physiotherapy is an important adjunct for optimal recovery:
o Improving mobilisation
o Supported coughing or modified coughing
o Ventilatory strategies
o Correct Discharge Advice and Progression

41
Q

Specific education following Gynae Surgery

A 
o No heavy lifting or vigorous activity
o Pelvic floor education and training
o Bladder and bowel education
o Life-style and behavioral training
o Gradual return
42
Q

Physiotherapy Management

Long term care gynae sugery

A

Addressing risk factors to prevent recurrence is important
 At an outpatient clinic:
o Ongoing symptoms and management – risks of de novo OAB and voiding
dysfunction
o Assessment of post-operative pain including dyspareunia
o Assessment of stage of healing and scar review
o Review of risk factors
o Pelvic floor strength and coordination
o Return to function program
o Supportive devices could be a consideration

Women's Health (11 decks)

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