Procedures Amenable to Combined Surgical Intervention

Most reconstructive procedures seem to be amenable to being combined. Some procedures, especially those performed through different incisions and approaches,may be

Table 13-5.1. Combining reconstructive surgical procedures

Amenability

Sphincteroplasty

ASCP/PVDR/Burch

+++

AR/sling/SSF

+++

PR

+

Abdominal rectopexy

ASCP

+/-

PVDR/Burch

+++

AR/PR/sling/SSF

+++

Perineal resection

ASCP/PVDR/Burch

+++

AR/sling

+++

PR/SSF

+

Colpocleisis

+/-

ASCP, abdominal sacrocolpopexy; PVDR, paravaginal defect repair; AR, anterior repair/colporrhaphy;SSF,sacrospinous fixation; PR, posterior repair/colporrhaphy.

ASCP, abdominal sacrocolpopexy; PVDR, paravaginal defect repair; AR, anterior repair/colporrhaphy;SSF,sacrospinous fixation; PR, posterior repair/colporrhaphy.

seen as more readily able to be combined. Those in which tissue is shared (i.e., those on either side of the rectovaginal septum) may require more consideration by one surgeon for the other surgeon's needs, but rarely have we found ourselves in a situation of jeopardizing a repair. Thus, there are some combinations of procedures that are better served as combined procedures (Table 13-5.1). Care must be taken when sharing the fascia of the rectovaginal septum. This thin layer of tissue can be jeopardized by direct trauma from either approach. Thus, care being taken to remain within tissue planes during dissection is important. When performing a combined anal sphincteroplasty and rectocoele repair, a preoperative decision should be made as to who will perform the levator plication, if it is to be performed, because it may affect the second procedure. If performed by both surgeons, restriction of rectal caliber may result.

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