57267 Insertion of mesh or other prosthesis for repair of pelvic floor defect, each site (anterior, posterior compartment), vaginal approach (List separately in addition to code for primary procedure)

Name of the Procedure:

Insertion of mesh or other prosthesis for repair of pelvic floor defect, each site (anterior, posterior compartment), vaginal approach.

Summary

This procedure involves placing a mesh or similar prosthetic material through the vaginal canal to support and repair weakened areas of the pelvic floor. It is often performed to address pelvic organ prolapse, where organs such as the bladder or rectum bulge into the vaginal canal due to weakened support structures.

Purpose

The procedure aims to restore the normal anatomy of the pelvic floor by providing added support to the pelvic organs. It helps relieve symptoms associated with pelvic organ prolapse like pressure, urinary incontinence, and bowel dysfunction.

Indications

• Symptoms of pelvic organ prolapse such as vaginal bulging, pressure, discomfort, urinary difficulties, or bowel issues.
• Failure of conservative treatments like pelvic floor exercises or pessaries.
• Recurrent prolapse following previous surgical repairs.

Preparation

• Pre-procedure fasting as instructed by the healthcare team.
• Adjusting or stopping certain medications, particularly anticoagulants.
• Complete diagnostic assessments, including pelvic exams and imaging studies.
• Discussing medical history and potential anesthesia reactions with the surgical team.

Procedure Description

1. Administer anesthesia (general, spinal, or local, depending on the case).
2. A small incision is made in the vaginal tissue.
3. The weakened area of the pelvic floor is identified.
4. The mesh or prosthetic material is inserted and secured to reinforce the pelvic floor support structures.
5. The vaginal incision is then closed with sutures.

Specialized surgical instruments and imaging may be used to ensure precise placement of the mesh.

Duration

The procedure typically takes 1 to 2 hours, depending on the complexity and number of sites being addressed.

Setting

This procedure is usually performed in a hospital or surgical center where appropriate facilities are available for anesthesia and surgical care.

Personnel

• Surgeon specialized in gynecology or urology.
• Anesthesiologist or nurse anesthetist.
• Surgical nurse and support staff.

Risks and Complications

• Common risks: Bleeding, infection, pain, and mesh erosion.
• Rare complications: Organ injury, fistula formation, chronic pain, and neuromuscular damage.
• Management involves antibiotics for infection or additional surgery for severe complications.

Benefits

• Reduction in symptoms of pelvic organ prolapse.
• Improved quality of life and physical function.
• Immediate benefits might be noticed, but full recovery and results typically emerge over several weeks.

Recovery

• Follow post-operative care instructions for wound care and activity restrictions.
• Expect to refrain from heavy lifting and strenuous activities for several weeks.
• Attend follow-up appointments to monitor healing and outcome.
• Pain management typically involves prescribed medications and adequate rest.

Alternatives

• Non-surgical options: Pelvic floor exercises, lifestyle changes, and use of pessaries.
• Comparatively, non-surgical options may be less effective for severe prolapse but carry fewer immediate risks.
• Alternative surgical options: Different surgical approaches without mesh, which may have a different risk profile and effectiveness.

Patient Experience

During the procedure, the patient is under anesthesia and feels no pain. Post-procedure, the patient may experience discomfort, swelling, or mild pain, managed with pain relief measures. There may be temporary restrictions on physical activities to allow proper healing and integration of the mesh.