Benefits of Combined Surgical Procedures

The multifactorial nature of PF dysfunction, especially as related to the impact on quality of life, must be kept in mind when planning surgical therapy. In most cases, an optimal outcome will not be achieved until all PF problems are addressed. As such, the concept of treating all PF problems at one surgical setting makes sense. There are very limited data as to outcomes and risks of concomitant surgeries. Most of the available data come from our reported experiences, here in Florida and in Cleveland.1-2 We have identified the following benefits:

1. Multiple PF defects are corrected at one time. In our experience, treatment outcomes from concomitantly performed procedures are not inferior to those of individually performed procedures.

2. Reduce overall recovery phase. The recovery phase from combined surgeries is not longer than that from single procedures. Thus, the sequential recovery phases from sequential surgeries are avoided.

3. Optimize ability to perform multiple procedures. Because many reconstructive procedures use the same support structures, subsequent procedures could be jeopardized because of scarring around the used structure. A good example of this is the usage of the sacral promontory for both sacrocolpopexy as well as rectopexy. There is typically no difficulty in sharing the promontory when performing a combined procedure (see Prolapse Syndromes Case Presentation, Chapter 8-8). Once scarring has developed from one procedure, achieving access to the sacral promontory for another procedure at a remote time can be impossible.

4. Reduce potential surgical complications. This relates primarily to anesthetic, thrombotic, and other surgery-related complications. We have not noted complications such as graft infection or a higher failure rate when combined procedures are performed.

5. Reimbursement issues. In the United States, insurance companies reimburse for multiple surgeries performed by one surgeon at one setting in a proportionate manner - 100% for the main procedure, 50% for the secondary, and 25% for the tertiary. This can be seen as a disincentive to performing multiple repairs at one setting. However, this does not apply to combined procedures performed by multiple surgeons of different specialties.

When a bowel resection procedure is performed, care should be taken to avoid fecal material spillage. This is particularly important if a synthetic or biologic graft will be used for urogynecologic reconstruction. We routinely perform abdominal sacrocolpopexy procedures at the same setting as resection rectopexy and have not found a higher graft infection rate. However, we are fastidious about avoiding fecal spillage and irrigate the operative field extensively.

How To Reduce Acne Scarring

How To Reduce Acne Scarring

Acne is a name that is famous in its own right, but for all of the wrong reasons. Most teenagers know, and dread, the very word, as it so prevalently wrecks havoc on their faces throughout their adolescent years.

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