DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Complete vaginal prolapse.
2. Urinary incontinence.
3. Enterocele.
POSTOPERATIVE DIAGNOSES:
1. Complete vaginal prolapse.
2. Urinary incontinence.
3. Enterocele.
OPERATION PERFORMED:
1. Abdominal sacral colpopexy with graft.
2. Halban culdoplasty.
3. Paravaginal repair.
SURGEON: John Doe, MD
ANESTHESIA: General.
DESCRIPTION OF OPERATION: The patient was prepped and draped in semi-lithotomy position after adequate general anesthesia had been induced. Examination revealed complete massive prolapse of the vagina. The vagina had keratinization and skin breakdown. After prepping the vagina and sterilely preparing the field, a Foley catheter was placed into the bladder and the prolapse was reduced with a double-sponge stick. The patient was then prepped and draped for abdominal surgery.
A low transverse incision was made with scalpel and carried through the subcutaneous tissue to the fascia. The fascia was nicked in the midline and carried bilaterally in a semilunar fashion. The cut edges were grasped with Allis clamp, dissected superiorly and inferiorly with blunt and sharp dissection. The muscles were separated. The peritoneal cavity was entered and extended under direct visualization. On entering the abdominal cavity, the bladder was noted to be markedly distended and flaccid.
Self-retaining O’Connor-O’Sullivan retractor was placed in the abdomen, the bowels were packed. The apex of the vagina was identified, grasped with two long Allis clamps. Using 0-Vicryl suture, a Halban culdoplasty was performed, placing the suture in the posterior vagina, major of the cul-de-sec and on the sigmoid serosa with total of five parallel sutures obliterating the cul-de-sac. The ureters was palpated, noted not to be impinged.
The posterior peritoneum was opened over the sacral promontory and carried down to the hollow of the sacrum with the Metzenbaum scissors. A suture of 0 Tevdek was sewn to the sacral promontory and tacked. A NovaSilk graft was placed into the posterior vagina with four sutures of 0 Tevdek with care taken not to penetrate the vaginal mucosa. The opposite end was then sewn into place at the sacral promontory with the previously placed suture in a horizontal mattress manner. The entire graft was buried retroperitoneally with using 2-0 Vicryl suture in a running fashion.
The space of Retzius was opened and the ureterovesical junction was identified. Using the operator’s hand in the vagina, the lateral fascia was identified and cleared of fat. It was grasped at approximately 0.5 cm distal, 1 cm lateral to the urethra and then 1 cm lateral to its mid portion with long Allis clamps and 0 Vicryl sutures were placed under the Allis clamps moving away from the bladder the entire time.
The bladder was then filled retrograde with 350 mL of blue-colored fluid in a retrograde manner. There was no evidence of injury to the bladder or leakage at the suture sites. The bladder was drained and the sutures were placed into the Cooper’s ligament. Avitene was placed in the space of Retzius to aid with scar formation, using the operator’s hand in the vagina as a guide, the sutures were tied, elevating the bladder.
Attention was turned to the abdomen. There was no evidence of bleeding. All sponge and instruments were removed. The counts were correct. The peritoneum was closed with running 2-0 Vicryl suture after a Seprafilm was placed in the abdomen to prevent adhesions.
The fascia was closed with running 0-PDS and the skin was closed with staples. Sponge and needle counts were correct. Hemostasis was excellent. The vagina was examined. She was bleeding nonbloody mucoid urine. Foley catheter was changed to single channel Foley. She went to recovery room in stable condition.
