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Laparoscopic pelvic floor corrective surgery

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13/05/2007

    • Evacuatory problems are common as they were present preoperatively!   They usually respond to oral senna ii nocte & ii glycerine supps 20 minutes after breakfast.  Occasional a microlax enema is required.  Movicol (2 sachets) is occasionally required.  Patients need to learn that evacuation is not all about pushing and straining - most people evacuate in response to a wave of peristalsis.
    • Occasionally a patient will develop genuine stress incontinence and require urological workup with cystoscopy and urodynamics.  The vast majority respond to a TVT repair.
    • Bruising around the ports is common (especially the 12mm).  Occasionally it can be sufficient to warrant a transfusion.  This is very uncommon (approx 1%) and is usually evident on the first postoperative day when the patient complains of flank pain arising from the subcutaneous swelling.  The tell tale bruise appears on the third day.
    • The RIF port may cause nerve irritation/neuropraxia - Amitriptyline 10mg can help.
    • If a patient complains of pain and vomiting - think about a port site hernia.
    • Mesh erosion through the vagina is very uncommon (0.5%).  It responds to prompt local surgery, partial mesh excision and vaginal closure with or without a vaginal advancement flap.
    Osteomylelitis of the sacral prominontry, L5 S1 discitis is a recognised complication of open sacrocolpopexy and rectopexy.  It usually follows a bacteraemia.  Patients present with SEVERE back pain, root pain.  Diagnosis requires an urgent MRI sacn.

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