Abstract
Vaginal surgery complications can at times be difficult to manage. Clearly the best management scheme entails steps to prevent complications. These steps require judicious preoperative planning with detailed knowledge of the patient’s case, operative anatomy, surgical indications, and expectations, as well as prudent use of preoperative diagnostic testing. This kind of preparation facilitates better recognition of intraoperative complications and consequent expeditious treatment.
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Removal of obturator mesh. Two oblique incisions are made in the distal vaginal area. The mesh entering the obturator fascia is isolated over silk sutures. A transverse incision is made on the anterior vaginal and two flaps are created. The mesh is dissected free from the urethral wall and divided in two. The mesh is followed toward the obturator fascia. The fascia is opened, dissecting the mesh from the posterior medial periosteum of the pubic bone, obturator internus, and obturator membrane. A separate incision is made lateral to the labia. The skin and subcutaneous tissues are dissected to expose the adductor fascia (gracilis and adductor longus). Under finger control in the vagina, the fascia is incised to expose the lateral margin of the lateral descending rami of the pubic bone. The mesh is isolated from the surrounding musculature and the periosteum. The mesh is transferred from the vaginal incision to the lateral labial incision and removed entirely. The same maneuver will be performed in the contralateral side. The vaginal wall and lateral labial incisions are closed (MP4 691239 kb)
Removal of retropubic mesh. Two vaginal incisions are made in the distal vagina. The mesh is isolated over silk sutures. A transverse incision is made over the vaginal wall and two flaps are created. The mesh is freed from the urethral wall and divided in two segments. The retropubic space is entered and the mesh freed from the periurethral fascia, the posterior inferior aspect of the pubic bone, and the obturator fascia. The dissection is carried out up to the superior margin of the pubic bone. Under finger control in the vagina, a transverse incision is made in the suprapubic area. The retropubic space is entered and the mesh dissected free from the surrounding musculature and periosteum of the pubic bone. The mesh is removed bilaterally. The vaginal wall and abdominal incisions are closed (MP4 440580 kb)
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Raz, S. (2015). Complications of Vaginal Surgery. In: Atlas of Vaginal Reconstructive Surgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-2941-2_9
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DOI: https://doi.org/10.1007/978-1-4939-2941-2_9
Publisher Name: Springer, New York, NY
Print ISBN: 978-1-4939-2940-5
Online ISBN: 978-1-4939-2941-2
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