Name of the Procedure:

Combined Anteroposterior Colporrhaphy, including Cystourethroscopy, with Enterocele Repair

Summary

Combined anteroposterior colporrhaphy with enterocele repair is a surgical procedure to correct pelvic organ prolapse, where the bladder, urethra, and small intestine protrude into or outside the vaginal canal. This procedure also involves inspecting the bladder and urethra (cystourethroscopy).

Purpose

The procedure is designed to address pelvic organ prolapse. Its goals are to restore normal anatomy, relieve symptoms like discomfort or incontinence, and improve the patient's quality of life.

Indications

This surgery is indicated for patients experiencing:

• Pelvic organ prolapse (anterior and posterior vaginal wall prolapse, enterocele)
• Symptoms like pelvic pressure, incontinence, or difficulty with bowel movements
• Failure of conservative treatments like pelvic floor exercises or pessaries

Preparation

Pre-procedure preparations may include:

• Fasting for 8-12 hours before surgery
• Adjusting or stopping certain medications as directed by the doctor
• Undergoing diagnostic tests like a pelvic exam, imaging studies, or urodynamic tests

Procedure Description

1. The patient is given anesthesia—general or spinal.
2. Surgical incisions are made in the vaginal wall to access the prolapsed organs.
3. The surgeon corrects the positioning of the bladder and urethra (anterior colporrhaphy) and repairs the rectal wall and small intestine (posterior colporrhaphy with enterocele repair).
4. Cystourethroscopy is performed to inspect the bladder and urethra for any abnormalities.
5. The incisions are closed with sutures.
6. Monitored recovery from anesthesia follows.

Tools and equipment include surgical instruments, sutures, and a cystoscope.

Duration

The procedure typically lasts 1.5 to 3 hours.

Setting

This surgery is generally performed in a hospital or a surgical center.

Personnel

Involvement includes:

• A surgeon specialized in gynecology or urogynecology
• An anesthesiologist
• Surgical nurses
• Possibly an assisting physician or surgical tech

Risks and Complications

Risks can include:

• Infection
• Bleeding
• Injury to surrounding organs (e.g., bladder or bowel)
• Recurrence of prolapse
• Pain or discomfort
• Complications related to anesthesia

Benefits

The expected benefits are the resolution of prolapse symptoms, improved support of pelvic organs, and enhanced quality of life. Benefits are typically realized soon after recovery, which can be a few weeks.

Recovery

Post-procedure care involves:

• Prescribed pain medications
• Instructions on wound care
• Avoiding heavy lifting and strenuous activities for 6-8 weeks
• Follow-up appointments to monitor healing

Alternatives

Other treatment options include:

• Non-surgical methods like pelvic floor physical therapy or pessaries
• Different surgical approaches, such as laparoscopic or robotic-assisted prolapse repairs

Each alternative has its own advantages and disadvantages compared to this combined procedure.

Patient Experience

Patients may experience discomfort and mild to moderate pain immediately following the procedure, managed with medications. During recovery, they should expect some restricted activity and follow specific care instructions to ensure proper healing and avoid complications.