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Vaginal and Paravaginal Repair and Repair of Pelvic Prolapse, Xenform Dermal Graft Implantation and Vaginal Colpopexy
DESCRIPTION OF OPERATION: The patient was brought to the operating suite. The patient was given anesthesia and prepped and draped in the dorsal lithotomy position, a 16-French Foley catheter in her urethra. Vaginal and labial retraction sutures were placed. On examination, the patient actually had more protrusion of the anterior wall and not only the cuff today. Anterior vaginal wall was grasped between Allis clamps and infiltrated with lidocaine with epinephrine. This was incised and the porcine graft was still in place. This dissection was below this level. Bladder was identified and swept off the anterior vaginal mucosa. As this was taken to the cuff, there was no enterocele sac identified. Ischial spines were felt on both sides. A paravaginal defect was created. The muscular incision superior and lateral to ischial spine was captured using a 0 PDS monofilament suture. The patient also had the urethra dissected and the prior mesh sling was identified at the mid urethral level. The patient had an 8 x 12 piece of Xenform bovine dermal graft cut in a triangular fashion with a slight central cut-out and several slits at the base. Then, 2-0 Vicryl colpopexy sutures were passed medial to the base of the triangle bilaterally. The monofilament suture was passed through the base of the triangle approximately 1 cm from the edge on each side. This was tied to itself. The other end of the monofilament suture was pulled on each side of the pulley stitch and the graft was tied down to the level of the ischial spine. The graft was unrolled and was tucked below the bladder. The apex and triangle were secured to the prior mid urethral sling using a 2-0 PDS suture. The distal apex was slightly trimmed. The patient had good hemostasis by this time. The colpopexy sutures were passed near the limit of the incision. The patient had a short posterior vaginal vault and this was lengthened. The patient had a 1.5 cm skin bridge on each side as the colpopexy sutures were passed through it. This was tied down for a good colpopexy and vaginal length additionally. The anterior vaginal wall was not trimmed. This was closed with a running 2-0 Vicryl suture and a vaginal packing was placed. The patient will be admitted postoperatively for observation.