Miko24
Guru
Preoperative Diagnosis:
1. Grade III Uterovaginal Prolapse
Postoperative Diagnosis:
1. Same
Procedure:
1. Cystoscopy
2. Sacrospinous ligament fixation
3. Anterior and posterior colporrhapy
4. Perineorrhaphy
Anesthesia:
General
Indications: 80-year-old female with symptomatic and bothersome primarily anterior vaginal prolapse also with mixed urinary incontinence. No stress incontinence provoked on urodynamics with prolapse reduced, so no prophylactic stress incontinence procedure performed. This decision was discussed with the patient had a time, she is aware that she may have residual urinary symptoms and incontinence postoperatively. But this would be able to be treated at that point.
FINDINGS: Stage III anterior prolapse, stage II apically prolapse, minimal posterior prolapse. Right-sided sacrospinous ligament fixation performed.
EBL: 0cc
Drains: none
Specimens: none
Procedure:
The patient was brought to the operating room and transferred to the OR table. She was placed in high lithotomy after induction of general anesthesia. She was prepped and draped in standard sterile fashion and time-out was performed. We then began with an intraoperative examination. She was noted to have minimal posterior laxity, so obliterative procedure would not be amenable. Patient had been counseled preoperatively about possibility of reconstructive procedure, so this was pursued instead. The anterior cystocele was grasped with Allis is, and the pubis cervical fascia was infiltrated with diluted lidocaine with epinephrine. A midline incision was performed and bilateral flaps were raised leaving the pubis cervical fascia intact over the bladder. This was performed all the way up to the level of the cervix. The prolapse was then reduced with 2-0 Vicryl sutures running Kelly plication. Attention was then turned to the right side where blunt dissection was performed to reach the sacral spinous ligament. The ligament was cleared off. A Capio slim suture device was utilized to place 2 Vicryl sutures to the sacral spinous ligament which were affixed to the a buccal vagina. The vagina was then suspended.
Cystoscopy was performed at this point showing bilateral effluxing ureteral orifice ease. No sign of bladder injury. A Foley catheter was placed with clear yellow drainage.
The anterior vaginal incision was closed with running 2 0 Vicryl.
She did also have an element of posterior prolapse with perineal thinning. A diamond-shaped wedge of epithelium was removed from the perineal body. This was extended up to the mid posterior vagina. Bilateral flaps were raised. A digital rectal exam was performed showing no rectal injury. At this point burning Kelly plication was performed posteriorly. The perineal body was reconstructed with a series of interrupted 2 0 Vicryl sutures to perform apparent or feet. This was all closed with a running 2 0 Vicryl.
Vaginal packing was placed, the patient was awoken from general anesthesia and taken to PACU for recovery.
57282 - N81.4
57260
1. Grade III Uterovaginal Prolapse
Postoperative Diagnosis:
1. Same
Procedure:
1. Cystoscopy
2. Sacrospinous ligament fixation
3. Anterior and posterior colporrhapy
4. Perineorrhaphy
Anesthesia:
General
Indications: 80-year-old female with symptomatic and bothersome primarily anterior vaginal prolapse also with mixed urinary incontinence. No stress incontinence provoked on urodynamics with prolapse reduced, so no prophylactic stress incontinence procedure performed. This decision was discussed with the patient had a time, she is aware that she may have residual urinary symptoms and incontinence postoperatively. But this would be able to be treated at that point.
FINDINGS: Stage III anterior prolapse, stage II apically prolapse, minimal posterior prolapse. Right-sided sacrospinous ligament fixation performed.
EBL: 0cc
Drains: none
Specimens: none
Procedure:
The patient was brought to the operating room and transferred to the OR table. She was placed in high lithotomy after induction of general anesthesia. She was prepped and draped in standard sterile fashion and time-out was performed. We then began with an intraoperative examination. She was noted to have minimal posterior laxity, so obliterative procedure would not be amenable. Patient had been counseled preoperatively about possibility of reconstructive procedure, so this was pursued instead. The anterior cystocele was grasped with Allis is, and the pubis cervical fascia was infiltrated with diluted lidocaine with epinephrine. A midline incision was performed and bilateral flaps were raised leaving the pubis cervical fascia intact over the bladder. This was performed all the way up to the level of the cervix. The prolapse was then reduced with 2-0 Vicryl sutures running Kelly plication. Attention was then turned to the right side where blunt dissection was performed to reach the sacral spinous ligament. The ligament was cleared off. A Capio slim suture device was utilized to place 2 Vicryl sutures to the sacral spinous ligament which were affixed to the a buccal vagina. The vagina was then suspended.
Cystoscopy was performed at this point showing bilateral effluxing ureteral orifice ease. No sign of bladder injury. A Foley catheter was placed with clear yellow drainage.
The anterior vaginal incision was closed with running 2 0 Vicryl.
She did also have an element of posterior prolapse with perineal thinning. A diamond-shaped wedge of epithelium was removed from the perineal body. This was extended up to the mid posterior vagina. Bilateral flaps were raised. A digital rectal exam was performed showing no rectal injury. At this point burning Kelly plication was performed posteriorly. The perineal body was reconstructed with a series of interrupted 2 0 Vicryl sutures to perform apparent or feet. This was all closed with a running 2 0 Vicryl.
Vaginal packing was placed, the patient was awoken from general anesthesia and taken to PACU for recovery.
57282 - N81.4
57260