Lateral Colporrhaphy
Lateral colporrhaphy is a surgical technique used to cosmetically tighten the vaginal mucosa and is indicated for vaginal laxity and decreased vaginal sensation, though data are limited regarding its effectiveness. The goal of lateral colporrhaphy is to e
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Lydia A. Fein, Carlos A. Medina, and Noor Joudi
Indications 1. Vaginal laxity 2. Decreased vaginal sensation
Essential Steps Preoperative Markings 1. The posterolateral aspect of the vaginal wall can be marked bilaterally at the introitus to ensure that the surgical incisions are symmetrical.
L.A. Fein, M.D., M.P.H. (*) Department of Obstetrics and Gynecology, University of Miami Miller School of Medicine, Miami, FL 33136, USA e-mail: [email protected] C.A. Medina, M.D. Department of Obstetrics and Gynecology, Division of Urogynecology (FPMRS), University of Miami Miller School of Medicine, Miami, FL 33136, USA e-mail: [email protected] N. Joudi, B.S. University of Miami Miller School of Medicine, Miami, FL 33131, USA e-mail: [email protected]
Intraoperative Details 1. General anesthesia. 2. Place patient in lithotomy position. 3. Properly prep the vulva (including mons pubis), vagina, and perineum. 4. Drain bladder with in-and-out catheter and avoid placing a Foley catheter. 5. Use a Lone Star retractor or Allis clamps to retract labia majora, labia minora, and introitus laterally (level of hymenal ring). 6. Infiltrate the bilateral posterolateral vagi nal walls with lidocaine with 1:100,000 epinephrine. 7. On each side of the vagina, resect an ellipse- shaped region of vaginal mucosa at the border of the lateral and posterior vaginal wall, extending from the introitus to the apex. The size of each ellipse depends on the desired level of tightening. 8. Reapproximate and close the remaining vaginal mucosa in one or two layers.
Postoperative Care 1. If patient cannot void spontaneously following surgery, insert a Foley catheter, and drain the bladder for the next 24 h. 2. Patients should be instructed to refrain from activities for several weeks that will cause strain on the surgical site, including lifting,
© Springer International Publishing Switzerland 2017 T.A. Tran et al. (eds.), Operative Dictations in Plastic and Reconstructive Surgery, DOI 10.1007/978-3-319-40631-2_26
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coughing, long periods of standing, sneezing, and straining with bowel movements. Pelvic rest for a minimum of 4–6 weeks (nothing introduced into the vagina/no sexual intercourse). 3. Postoperative follow-up scheduled at 1–2 week, 6 weeks, 3 months, and 6 months.
Possible Complications 1. Localized infection. 2. Postoperative bleeding. 3. Wound breakdown. 4. Recurrent vaginal laxity or decreased sensation. 5. Overcorrection resulting in a very narrow vaginal canal. 6. Vaginal pain. 7. Dyspareunia. 8. Granulation tissue. 9. Other complications are very rare but may include cystotomy, proctotomy, fistula, and others.
Operative Dictation Diagnosis: Vaginal laxity Procedure: Lateral colporrhaphy
Description of the Procedure The patient was taken to the operating room and placed in supine position. Sequential compression devices were applied to lower extremities. General anesthesia was induced. Once under anesthesia, she was placed in lithotomy position. A time-out was done and the patient
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