Operation: Anterior / Posterior Vaginal Repair (Colporrhaphy)
Date: _______________
Surgeon: _______________
Assistant(s): _______________
Anesthesia: Spinal / epidural / GA with ET tube
Anesthesiologist: _______________
PreOp Dx: Pelvic Organ Prolapse (Cystocele, Rectocele, etc)
Post Op Dx: same

  1. Anterior Colporrhaphy / Anterior Vaginal Repair
  2. Posterior Colporrhaphy / Posterior Vaginal Repair (with/without perineorrhaphy)
Operative Findings:
  1. Grade 2 cystocele
  2. Grade 2 rectocele
  3. Well supported uterus/cervix without prolapse
  1. trimmed vaginal mucosa from anterior / posterior vaginal wall
Estimated Blood Loss: 150cc
Complications: None.

Clinical Note: Ms. _______________ is a 65 year old patient who has a longstanding history of pelvic organ prolapse to which she has now become symptomic. After conservative management and an unsuccessful trial of a pessary, she elected to have surgical management. She was councelled and aware of the risks of surgery as well as the potential for recurrence, chronic pelvic pain, and dysparunia. Consent was signed in the clinic and she was cleared for surgery by anesthesia.

Procedure Note:
Under [GA/spinal/epidural] anethesia in the dorsal lithotomy position, the patient was prepped and drapped in the usual sterile fashion. A foley catheter was placed into the bladder and the bladder was drained for ___ mL. An examination under anesthesia revealed [operative findings reported above]. [Optional: For visualization and to improve the working field, the labia were retracted with #2-0 labial sutures bilaterally.] A weighted speculum was then placed in the vagina and the cystocele/rectocele was exposed.

For Cystocele / Anterior Repair

A dilute [vasopressin/lidocaine/marcaine] solution was infiltrated under the anterior vaginal mucosa midline. A small incision was made in the vaginal mucosa [at the vaginal vault/just above the cervix] and the Metzenbaum scissors were then used to dissect the mucosa off of the cystocele and cut the vaginal mucosa in the midline. The cut edges were held and splayed laterally with a series of [Allis/Kochers/T- clamps]. The bladder was dissected away along the lateral edges with a combination of sharp and blunt dissection, exposing the vesicovaginal space. A series of #2-0 Vicryl interrupted sutures were then placed sequentially along the lateral folds of the vesicovaginal space and brought together to tuck the bladder back while simultaneously bringing the lateral vaginal tissues together. The excess vaginal mucosa was then trimmed. The vagina was then closed with a running locked #0 Vicryl suture.

The foley catheter was removed and a 70 degree cystoscope was inserted into the bladder. The bladder was intact and normal looking, with no evidence of trauma or perforation. Bilateral ureteric jets were visualized. The bladder was drained through the sheath of the cystoscope, and then the cystoscope was removed. [The foley catheter was then reinserted.]

For Rectocele / Posterior Vaginal Repair

A dilute [vasopressin/lidocaine/marcaine] solution was infiltrated under the posterior vaginal mucosa midline and into the perineal body. An [inverted triangle/diamond of skin / transverse incision] was cut in the perineum. The posterior vaginal wall was opened vertically and midline up to the apex of the rectocele. The cut edges were held and splayed laterally with a series of [Allis/Kochers/T-clamps]. The open vaginal mucosa was then dissected laterally with a combination of sharp and blunt dissection, exposing the perirectal fascia. The perirectal fascia was then reapproximated with interrupted #2-0 Vicryl sutures to draw the lateral folds together and tuck the rectocele back. Deep interrupted sutures of #0 Vicryl were used to reapproximate the fibers of the levator ani muscles. The excess vaginal mucosa was trimmed. The posterior vaginal wall was closed with a running locked #0 Vicryl to the hymenal tags. The superficial perineal muscles were closed with running unlocked #0 Vicryl and the perineal skin was closed with running subcuticular #2-0 Vicryl.

Special Case for Enteroceles: The enterocele sac was identified and isolated from the vaginal mucosa until feely moveable. The sac was opened and trimmed. A series of #2-0 PDS sutures were introduced beginning at the deepest point of enterocele sac such that it obliterated.

Rectal exams were repeated throughout the repair and at the end to ensure there were no sutures penetrating rectal tissue.

At the end of the procedure, all sponges, instruments, and sharps were counted and correct. The estimated blood loss was (xxx) ml. The foley catheter was draining clear urine and removed. The patient tolerated the procedure well and was taken to the PACU in stable condition.