58263 Vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s), and/or ovary(s), with repair of enterocele

Name of the Procedure:

Vaginal Hysterectomy with Salpingo-Oophorectomy and Enterocele Repair

Summary

A vaginal hysterectomy is a surgical procedure where the uterus, and sometimes one or both of the fallopian tubes and ovaries, are removed through the vagina. This particular procedure also includes the repair of an enterocele, which is a hernia-like condition where a part of the intestine pushes down into the pelvic area.

Purpose

This procedure is conducted to treat several gynecological conditions such as uterine prolapse, fibroids, heavy menstrual bleeding, endometriosis, chronic pelvic pain, or cancer of the uterus, ovaries, or cervix. The expected outcome is the removal of the problematic uterus and any additional diseased tissue, resulting in symptom relief and prevention of further health complications.

Indications

• Symptomatic uterine prolapse
• Abnormal uterine bleeding
• Large fibroids causing pain or bleeding
• Endometrial hyperplasia or early-stage cancer
• Chronic pelvic pain
• Endometriosis
• Severe infection or irreversible damage to the uterus
• Patient's specific health history warrants it

Preparation

• Fasting: Patients are usually required to fast for at least 8 hours prior to surgery.
• Medication adjustments: Instructions will be given on which medications to stop or adjust.
• Diagnostic Tests: Blood tests, pelvic ultrasound, Pap smear, and other relevant imaging or diagnostic tests might be required.
• Pre-operative consultation: Discussion of medical history, current medications, and any allergies with the healthcare provider.

Procedure Description

1. Anesthesia: General anesthesia is typically administered.
2. Incision: Small incisions are made in the vaginal wall.
3. Dissection: The surgeon carefully dissects and detaches the uterus from its surrounding structures including the fallopian tubes and ovaries if they are to be removed.
4. Removal: The uterus (along with tubes and/or ovaries if necessary) is removed through the vaginal opening.
5. Enterocele Repair: The surgeon repairs any herniations into the pelvic cavity by repositioning and securing the tissues.
6. Closure: The incisions are stitched up, and necessary measures are taken to minimize bleeding and ensure proper healing.

Tools may include standard surgical instruments, laparoscopic equipment, and suturing materials.

Duration

The procedure typically lasts between 1 to 3 hours, depending on the complexity.

Setting

This procedure is usually performed in a hospital operating room or a specialized surgical center.

Personnel

• Surgeon (Gynecologist)
• Surgical Nurses
• Anesthesiologist
• Surgical Technicians

Risks and Complications

• Common risks: Bleeding, infection, and reaction to anesthesia
• Rare but serious complications: Damage to adjacent organs (bladder, intestines), blood clots, deep vein thrombosis (DVT), urinary incontinence, and pelvic organ prolapse.

Benefits

• Relief from symptoms such as pain, heavy bleeding, and pressure
• Reduced risk of cancer or advances in pre-cancerous conditions
• Enhanced quality of life
• Benefits are typically realized immediately after recovery but might take a few weeks to fully appreciate.

Recovery

• Post-operative care: Medications for pain, antibiotics to prevent infection, and instructions for wound care.
• Restrictions: Avoid heavy lifting and strenuous activities for 6-8 weeks.
• Recovery time: Generally, 4 to 6 weeks
• Follow-up appointments: Regular check-ups with the surgeon to monitor healing and address any concerns.

Alternatives

• Medication to manage symptoms
• Uterine artery embolization for fibroids
• Endometrial ablation for heavy bleeding
• Non-surgical management with hormone therapy
• Pros and cons: Surgery provides a permanent solution but comes with risks; non-surgical options are less invasive but may not be as effective long-term.

Patient Experience

During the procedure, the patient will be under anesthesia and should not feel any pain. Post-procedure, some discomfort, bleeding, and swelling are common. Pain management will be provided through medications. Most patients report a significant improvement in their symptoms and overall function within a few weeks post-surgery. Regular follow-up and adherence to the post-operative instructions are crucial for optimal recovery.