Repair of enterocele, vaginal approach (separate procedure)
CPT4 code
Name of the Procedure:
Repair of enterocele, vaginal approach (separate procedure)
Common Name: Vaginal enterocele repair
Medical Term: Posterior vaginal repair, enterocele repair
Summary
This surgical procedure involves repairing an enterocele, which is a type of pelvic organ prolapse where a portion of the small intestine descends into the lower pelvic cavity, pressing against the vaginal wall. The repair is performed through the vaginal approach, meaning the surgery is done via an incision in the vagina rather than through the abdomen.
Purpose
Condition Addressed: Enterocele, a prolapse of the small intestine into the vaginal space.
Goals/Expected Outcomes: To restore the normal positioning of the pelvic organs, relieve symptoms such as pelvic pressure or discomfort, and prevent recurrence of the prolapse.
Indications
Symptoms or Conditions:
- Pelvic pressure or heaviness
- Lower back pain
- Difficulty with bowel movements
- Pain during intercourse
Patient Criteria:
- Diagnosed with enterocele
- Symptoms affecting quality of life
- Failed conservative treatments like pelvic floor therapy
Preparation
Pre-procedure Instructions:
- Fasting for at least 8 hours before the procedure
- Adjust or stop certain medications as advised by your doctor
- Undergo a preoperative physical examination and necessary lab tests (e.g., blood tests, imaging)
Procedure Description
- Anesthesia: The patient is given either general anesthesia or regional anesthesia (e.g., spinal or epidural).
- Incision: A surgical incision is made in the vaginal wall.
- Reduction: The prolapsed small intestine is moved back into its correct position.
- Repair: The pelvic floor is reinforced using sutures and sometimes mesh to support the vaginal wall.
- Closure: The incision in the vaginal wall is closed with sutures.
Tools/Equipment:
- Surgical instruments (scalpels, scissors, sutures)
- Possible use of synthetic mesh for reinforcement
Duration
The procedure typically takes about 1-2 hours.
Setting
The repair is performed in a hospital or surgical center, often as an outpatient procedure.
Personnel
- Gynecologist or Urogynecologist (surgeon)
- Anesthesiologist or Nurse Anesthetist
- Surgical Nurses and Technicians
Risks and Complications
Common Risks:
- Bleeding
- Infection
- Pain or discomfort
Rare Complications:
- Injury to surrounding organs (bladder, bowel)
- Recurrence of enterocele
- Issues related to mesh use (if applicable), such as erosion or rejection
Benefits
Expected Benefits:
- Relief from symptoms of prolapse
- Improved quality of life
- Restored anatomical function and support
Timeframe: Benefits are generally realized within a few weeks post-procedure.
Recovery
Post-procedure Care:
- Pain management with prescribed medications
- Avoiding heavy lifting, strenuous activity, and sexual intercourse for 6-8 weeks
- Follow-up appointments to monitor healing
Expected Recovery Time: About 6-8 weeks
Restrictions: Limited physical activity for several weeks post-surgery; adherence to follow-up schedules.
Alternatives
Other Treatment Options:
- Pelvic floor physical therapy
- Pessary (a device inserted into the vagina to support pelvic organs)
- Observation if symptoms are mild
Pros and Cons of Alternatives:
- Pelvic therapy and pessaries are less invasive but may not be effective for severe cases.
- Observation avoids surgery but doesn’t correct the prolapse.
Patient Experience
During Procedure: Anesthesia ensures the patient feels no pain; there may be pressure or minimal discomfort during the procedure prep.
After Procedure:
- Mild to moderate pain managed with medication
- Possible vaginal discharge or spotting
- Gradual return to normal activities within a few weeks
Pain Management: Prescribed medications, rest, and possibly ice packs.