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Intraoperative Complications of Vaginal Surgery

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Abstract

Pelvic reconstructive surgery is not devoid of complications, some minor and some more serious. This chapter covers the most common injuries ranging from positioning nerve damage to bladder, ureteral, rectal, or urethral injury. A movie on the vaginal repair of a bladder injury during a laparoscopic vaginal hysterectomy illustrates some of the key steps to achieve a complete repair. The vaginal surgeon should be attentive to pre-existing factors that may place the patient at risk and have a game plan to deal with any complications should they arise.

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References

  1. Lambrou NC, Buller JL, Thompson JR, et al. Prevalence of perioperative complications among women undergoing reconstructive pelvic surgery. Am J Obstet Gynecol. 2000;183:1355.

    Article  CAS  PubMed  Google Scholar 

  2. Mann WJ, Arato M, Patsner B, et al. Ureteral injuries in an obstetrics and gynecology training program: etiology and management. Obstet Gynecol. 1988;72:82.

    CAS  PubMed  Google Scholar 

  3. Lee RA, Symmonds RE, Williams TJ. Current status of genitourinary fistula. Obstet Gynecol. 1988;72:313.

    CAS  PubMed  Google Scholar 

  4. Mathevet P, Valencia P, Cousin C, et al. Operative injuries during vaginal hysterectomy. Eur J Obstet Gynecol Reprod Biol. 2001;97:71.

    Article  CAS  PubMed  Google Scholar 

  5. Handa VL, Harvey L, Cundiff GW, et al. Perioperative complications of surgery for genital prolapse: does concomitant anti-incontinence surgery increase complications? Urology. 2005;65:483.

    Article  PubMed  Google Scholar 

  6. Vaislic CD, Dalibon N, Ponzio O, et al. Outcomes in cardiac surgery in 500 consecutive Jehovah’s Witness patients: 21 year experience. J Cardiothorac Surg. 2012;7:95.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Trzcinski R, Kujawski R, Mik M, et al. Surgery in Jehovah’s Witnesses – our experience. Prz Gastroenterol. 2015;10:33.

    PubMed  PubMed Central  Google Scholar 

  8. Goldman HB. Complications of Female Incontinence and Pelvic Reconstructive Surgery. New York: Springer Science & Business Media; 2012.

    Google Scholar 

  9. Wolf Jr JS, Bennett CJ, Dmochowski RR, et al. Best practice policy statement on urologic surgery antimicrobial prophylaxis. J Urol. 2008;179:1379.

    Article  PubMed  Google Scholar 

  10. Kjolhede P, Halili S, Lofgren M. The influence of preoperative vaginal cleansing on postoperative infectious morbidity in abdominal total hysterectomy for benign indications. Acta Obstet Gynecol Scand. 2009;88:408.

    Article  PubMed  Google Scholar 

  11. Kjolhede P, Halili S, Lofgren M. Vaginal cleansing and postoperative infectious morbidity in vaginal hysterectomy. A register study from the Swedish National Register for Gynecological Surgery. Acta Obstet Gynecol Scand. 2011;90:63.

    Article  PubMed  Google Scholar 

  12. Ballard RM, Bradley-Watson PJ, Johnstone FD, et al. Low doses of subcutaneous heparin in the prevention of deep vein thrombosis after gynaecological surgery. J Obstet Gynaecol Br Commonw. 1973;80:469.

    Article  CAS  PubMed  Google Scholar 

  13. Tulikangas PK, Weber AM, Larive AB, et al. Intraoperative cystoscopy in conjunction with anti-incontinence surgery. Obstet Gynecol. 2000;95:794.

    CAS  PubMed  Google Scholar 

  14. Katske FA, Raz S. Use of Foley catheter to obtain transvaginal tamponade. Urology. 1987;18.

    Google Scholar 

  15. Anger JT, Weinberg AE, Gore JL, et al. Thromboembolic complications of sling surgery for stress urinary incontinence among female Medicare beneficiaries. Urology. 2009;74:1223.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Solomon ER, Frick AC, Paraiso MF, et al. Risk of deep venous thrombosis and pulmonary embolism in urogynecologic surgical patients. Am J Obstet Gynecol. 2010;203:510 e1.

    Article  Google Scholar 

  17. Maxwell GL, Synan I, Dodge R, et al. Pneumatic compression versus low molecular weight heparin in gynecologic oncology surgery: a randomized trial. Obstet Gynecol. 2001;98:989.

    CAS  PubMed  Google Scholar 

  18. Staskin DR, Hadley HR, Zimmern P, et al. Preoperative, intraoperative, and postoperative management of vaginal surgery. Semin Urol. 1986;4:7.

    CAS  PubMed  Google Scholar 

  19. Elard S, Cicco A, Salomon L, et al. Embolization for arterial injury incurred during tension-free vaginal tape procedure. J Urol. 2002;168:1503.

    Article  PubMed  Google Scholar 

  20. Otton GR, Mandapati S, Streatfeild KA, et al. Transfusion rate associated with hysterectomy for benign disease. Aust N Z J Obstet Gynaecol. 2001;41:439.

    Article  CAS  PubMed  Google Scholar 

  21. Stanford EJ, Paraiso MF. A comprehensive review of suburethral sling procedure complications. J Minim Invasive Gynecol. 2008;15:132.

    Article  PubMed  Google Scholar 

  22. Ford AA, Rogerson L, Cody JD, et al. Mid-urethral sling operations for stress urinary incontinence in women. Cochrane Database Syst Rev. 2015;(7):CD006375.

    Google Scholar 

  23. Aungst M, Wagner M. Foley balloon to tamponade bleeding in the retropubic space. Obstet Gynecol. 2003;102:1037.

    PubMed  Google Scholar 

  24. Kuuva N, Nilsson CG. A nationwide analysis of complications associated with the tension-free vaginal tape (TVT) procedure. Acta Obstet Gynecol Scand. 2002;81:72.

    Article  PubMed  Google Scholar 

  25. Zilbert AW, Farrell SA. External iliac artery laceration during tension-free vaginal tape procedure. Int Urogynecol J Pelvic Floor Dysfunct. 2001;12:141.

    Article  CAS  PubMed  Google Scholar 

  26. McLennan MT, Barr SA, Melick CF, et al. Bladder perforation during tension-free vaginal tape procedures: abdominal versus vaginal approach. Female Pelvic Med Reconstr Surg. 2012;18:25.

    Article  PubMed  Google Scholar 

  27. Boustead GB. The tension-free vaginal tape for treating female stress urinary incontinence. BJU Int. 2002;89:687.

    Article  CAS  PubMed  Google Scholar 

  28. Dmochowski RR, Blaivas JM, Gormley EA, et al. Update of AUA guideline on the surgical management of female stress urinary incontinence. J Urol. 2010;183:1906.

    Article  PubMed  Google Scholar 

  29. Andonian S, Chen T, St-Denis B, et al. Randomized clinical trial comparing suprapubic arch sling (SPARC) and tension-free vaginal tape (TVT): one-year results. Eur Urol. 2005;47:537.

    Article  PubMed  Google Scholar 

  30. Hilton P, Rose K. The “learning curve” for retropubic mid-urethral sling procedures: a retrospective cohort study. Int Urogynecol J. 2016;27:565.

    Article  PubMed  Google Scholar 

  31. Maher C, Feiner B, Baessler K, et al. Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev. 2013;(4): CD004014.

    Google Scholar 

  32. Lavelle RS, Christie AL, Alhalabi F, et al. Risk of prolapse recurrence after native tissue anterior vaginal suspension procedure with intermediate to long-term followup. J Urol. 2015; 195(4P1):1014–20.

    Google Scholar 

  33. Guerriero WG. Operative injury to the lower urinary tract. Clin Obstet Gynaecol. 1985;12:465.

    CAS  PubMed  Google Scholar 

  34. Kursh ED, Morse RM, Resnick MI, et al. Prevention of the development of a vesicovaginal fistula. Surg Gynecol Obstet. 1988;166:409.

    CAS  PubMed  Google Scholar 

  35. Hernandez RD, Himsl K, Zimmern PE. Transvaginal repair of bladder injury during vaginal hysterectomy. J Urol. 1994;152:2061.

    CAS  PubMed  Google Scholar 

  36. Wang Y, Hadley HR. The use of rotated vascularized pedicle flaps for complex transvaginal procedures. J Urol. 1993;149:590.

    CAS  PubMed  Google Scholar 

  37. Doyle PJ, Lipetskaia L, Duecy E, et al. Sodium fluorescein use during intraoperative cystoscopy. Obstet Gynecol. 2015;125:548.

    Article  CAS  PubMed  Google Scholar 

  38. Stanhope CR, Wilson TO, Utz WJ, et al. Suture entrapment and secondary ureteral obstruction. Am J Obstet Gynecol. 1991;164:1513.

    Article  CAS  PubMed  Google Scholar 

  39. Turner LC, Lavelle ES, Shepherd JP. Comparison of complications and prolapse recurrence between laparoscopic and vaginal uterosacral ligament suspension for the treatment of vaginal prolapse. Int Urogynecol J. 2015; 27(5):797–803.

    Google Scholar 

  40. Barber MD, Brubaker L, Burgio KL, et al. Comparison of 2 transvaginal surgical approaches and perioperative behavioral therapy for apical vaginal prolapse: the OPTIMAL randomized trial. JAMA. 2014;311:1023.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Visco AG, Taber KH, Weidner AC, et al. Cost-effectiveness of universal cystoscopy to identify ureteral injury at hysterectomy. Obstet Gynecol. 2001;97:685.

    CAS  PubMed  Google Scholar 

  42. Brandes S, Coburn M, Armenakas N, et al. Diagnosis and management of ureteric injury: an evidence-based analysis. BJU Int. 2004;94:277.

    Article  PubMed  Google Scholar 

  43. Pettit PD, Petrou SP. The value of cystoscopy in major vaginal surgery. Obstet Gynecol. 1994;84:318.

    CAS  PubMed  Google Scholar 

  44. Harris RL, Cundiff GW, Theofrastous JP, et al. The value of intraoperative cystoscopy in urogynecologic and reconstructive pelvic surgery. Am J Obstet Gynecol. 1997;177:1367.

    Article  CAS  PubMed  Google Scholar 

  45. Gilmour DT, Dwyer PL, Carey MP. Lower urinary tract injury during gynecologic surgery and its detection by intraoperative cystoscopy. Obstet Gynecol. 1999;94:883.

    CAS  PubMed  Google Scholar 

  46. Kasyan G, Abramyan K, Popov AA, et al. Mesh-related and intraoperative complications of pelvic organ prolapse repair. Cent Eur J Urol. 2014;67:296.

    Google Scholar 

  47. Daneshgari F, Kong W, Swartz M. Complications of mid urethral slings: important outcomes for future clinical trials. J Urol. 2008;180:1890.

    Article  PubMed  Google Scholar 

  48. Hoffman MS, Lynch C, Lockhart J, et al. Injury of the rectum during vaginal surgery. Am J Obstet Gynecol. 1999;181:274.

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Michael J. Belsante MD .

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Repair of bladder injury during laparoscopic assisted vaginal hysterectomy (MP4 42383 kb)

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Belsante, M.J., Zimmern, P.E. (2017). Intraoperative Complications of Vaginal Surgery. In: Zimmern, P., De, E. (eds) Native Tissue Repair for Incontinence and Prolapse. Springer, Cham. https://doi.org/10.1007/978-3-319-45268-5_19

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  • DOI: https://doi.org/10.1007/978-3-319-45268-5_19

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-45266-1

  • Online ISBN: 978-3-319-45268-5

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