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Anterior and Posterior Colporrhaphy

Anterior and Posterior Colporrhaphy . Brielle Bowyer & Tyson Howes. What is this procedure?. An Anterior and Posterior Colporrhaphy is done to repair herniations of the bladder and/or rectum through defects in the vaginal vault. Causes. Difficult Vaginal Births Multiple Births

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Anterior and Posterior Colporrhaphy

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  1. Anterior and Posterior Colporrhaphy Brielle Bowyer & Tyson Howes

  2. What is this procedure? • An Anterior and Posterior Colporrhaphy is done to repair herniations of the bladder and/or rectum through defects in the vaginal vault.

  3. Causes • Difficult Vaginal Births • Multiple Births • Use of forceps during delivery • Perineal tears and episiotomy during delivery • Strain from heavy lifting • Chronic cough or constipation • Weakening of vaginal muscles

  4. Equipment • Preferred Stirrups • Bovie • Headlamp

  5. Instrumentation and Supplies • Vaginal hysterectomy set • D & C set (if needed) • Basic vaginal set-up • Surgeon-specific sutures and dressings.

  6. Operative Prep • Anesthesia • General • Position • Lithotomy • Prep • Vaginal Prep • Indwelling Catheter • Draping • Lithotomy

  7. Anterior Repair Procedure • Transverse incision made at the union of the vaginal mucosa and cervix. • Continued down to pubovesical cervical fascia. • The vaginal mucosa is dissected from the pubovesical and cervical fascia and is opened in the midline until 1 cm-ish from urethral meatus. • Dissection continues until the bladder and urethra are separated from the vaginal mucosa. • Synthetic absorbable sutures placed in the pubovesical and cervical fascia. • Cystocele is reduced. • Excessive vaginal mucosa is removed. • Vaginal mucosa is closed in the midline with interrupted 0 synthetic absorbable sutures.

  8. Cystocele Repair

  9. Posterior Repair Procedure • Allis-Adair clamps are placed on the posterior vaginal mucosa and elevated to create a triangle. • An Allis clamp is placed at the top of the rectocele in the midline. • A transverse incision is made at the posterior fourchette. • Blunt dissection is used to separate the posterior vaginal mucosa from the perirectal fascia. • V-shaped portion of the mucosa is excised as determined by extent of repair required. • Vertical incision is made in the posterior vaginal mucosa and the edges are retracted. • The perirectal fascia is bluntly dissected from the posterior vaginal mucosa. • Rectocele is reduced with finger and levatorani muscles are sutured together. • Closure and dressing

  10. Rectocele Repair

  11. Post-Op Considerations • Immediate Post-op Care • Transport to PACU. • Observe color and amount of urine in urine drainage bag. • Prognosis • Return to normal activities. • Complications • Post-op bleeding • Hematoma • UTI • Inability to urinate or stress incontinence • Shortened or narrowed vagina • Rectovaginal fistula • Wound infection • Recurrence of herniation

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