57423 Paravaginal defect repair (including repair of cystocele, if performed), laparoscopic approach

Name of the Procedure:

Paravaginal Defect Repair (including repair of cystocele, if performed), Laparoscopic Approach

Summary

Paravaginal defect repair is a minimally invasive surgical procedure to fix defects in the pelvic tissues that support the bladder. Often, it includes the repair of a cystocele (a condition where the bladder bulges into the vaginal wall).

Purpose

This procedure addresses pelvic organ prolapse, specifically the descent of the bladder and vaginal walls. The goal is to restore normal anatomy, relieve symptoms such as urinary incontinence and pelvic pressure, and improve the quality of life.

Indications

• Symptoms of pelvic organ prolapse (e.g., pelvic pressure, urinary incontinence).
• Visual or physical diagnosis of bladder prolapse (cystocele).

• Failure of non-surgical treatments such as pelvic floor exercises or pessaries.

  Preparation

• Fasting 8-12 hours before surgery.
• Preoperative lab work and imaging studies.
• Possible adjustments to current medications, especially blood thinners.
• Pre-surgical clearance from primary care physician or cardiologist, if necessary.

Procedure Description

1. Anesthesia: General anesthesia is typically administered.
2. Incisions: Small incisions are made in the abdomen to insert a laparoscope and surgical instruments.
3. Repair: The surgeon lifts the bladder and vaginal walls back to their normal positions and secures them using sutures, mesh, or other supportive materials.
4. Closure: The incisions are closed with sutures or surgical glue.

Duration

The procedure generally takes 2-3 hours.

Setting

Typically performed in a hospital operating room or a specialized surgical center.

Personnel

• Gynecologist or Pelvic Surgeon
• Surgical Nurses
• Anesthesiologist
• Surgical Technicians

Risks and Complications

• Common risks: infection, bleeding, pain at the incision site.
• Rare risks: injury to surrounding organs (bladder, bowel), blood clots, mesh complications, anesthesia-related issues.
• Management: Post-operative monitoring, antibiotics, pain management protocols.

Benefits

• Relief from symptoms of pelvic organ prolapse.
• Improved urinary function.
• Enhanced quality of life.
• Benefits are usually noticeable within weeks post-surgery.

Recovery

• Hospital stay: Typically 1-2 days post-surgery.
• Activity: Limited physical activity for 4-6 weeks; avoid heavy lifting.
• Follow-up: Regular appointments to monitor healing and address any issues.
• Pain: Typically managed with medications; patients may experience discomfort in the initial days post-surgery.

Alternatives

• Non-surgical options: Pelvic floor exercises, pessaries, lifestyle modifications.
• Other surgical approaches: Vaginal or open abdominal approach.
• Pros and Cons: Non-surgical options are less invasive but may be less effective for advanced cases; different surgical approaches have varying recovery times and risks.

Patient Experience

• During: The patient will be under general anesthesia and will not feel pain during the procedure.
• After: Some pain and discomfort are common after waking from anesthesia; pain management will be provided.
• Full recovery: Patients usually return to normal activities within 6-8 weeks, with significant improvement in symptoms typically seen within weeks.