By Robert S. and Zimmerman, Carl W. Kovac
This text/DVD package deal is a step by step, completely illustrated advisor to cutting-edge strategies in vaginal surgical procedure. The publication info the most recent recommendations and applied sciences for working throughout the vagina, records the facts assisting the vaginal method of such a lot hysterectomies, and describes vaginal reconstructive surgical procedures for correcting many anatomic defects that reason sufferer difficulties. beginning sections assessment pelvic anatomy and talk about instruments for vaginal surgical procedure, together with antibiotic prophylaxis. next sections specialise in particular surgical procedures, together with hysterectomies, reconstruction of the vagina, and strategies for treating urinary incontinence, colorectal difficulties, and fistulas. the ultimate part discusses reputation and administration of intraoperative and postoperative problems. A bound-in DVD includes electronic video clips of vaginal hysterectomy, fix of the anterior vaginal section, site-specific colpocleisis, and overall procendentia.
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Additional info for Advances in Reconstructive Vaginal Surgery
This connective tissue sheath is thickest at the arcus tendineus fasciae pelvis and the uterosacral ligaments, but its course could be followed intact even in the less dense areas surrounding the urethra and vaginal tube. There is an anatomic plane separating the vagina from the overlying bladder and underlying rectum that has a tough overlying connective tissue sheath. It is this connective tissue sheath, described separately by Richardson et al. and later Baden and Walker, which is the crucial structure leading to the concept of site-specific pelvic support defects and their surgical repair (7,8).
Occasionally, cul-de-sac adhesions can challenge the surgeon. The rectum can be adherent here, and, therefore, entered by sharp dissection. Because the rectum should have been mechanically cleansed preoperatively, the surgeon can mobilize the rectum, thoroughly lavage the surgical field, and close the entry site with two layers of absorbable suture. The patient should have antibiotics for 24 hours and the stools kept soft. Be sure to fully explain the entry to the patient and her family, answer all questions objectively, document, and follow the patient closely for any symptoms or signs of peritonitis.
The urethral sphincter may either be very weak or the urethra is scarred open from prior surgery. Patients with these findings are at increased risk for surgical failure when treating urinary stress incontinence, a fact that may aid in patient counseling (11,12). The patient whose stress test is positive shortly after voiding, who has low residual urine, is also at risk for greatly compromised urethral sphincter function (13).