References

1. Beck DE, Wexner SD, eds. Fundamentals of Anorectal Surgery. London: WB Saunders; 1998:127-132.

2. Corman ML, ed. Colon and Rectal Surgery. 4th ed. Philadelphia: Lippincott Williams & Wilkins; 1998:301-305, 380-385.

3. Gordon PH, Nivatvongs S, eds. Principles and Practice of Surgery for the Colon, Rectum, and Anus. 2nd ed. St. Louis: Quality Medical Publishing; 1999:376-378, 1199-1204.

4. Karpman E, Das S, Kurzrock EA. Laparoscopic antegrade continence enema (Malone) procedure: description and illustration of technique. J Endourol 2002;16(6):325-328.

Section XIII

Surgical Therapy: Mutual and Combined

Aspects

Section XIII

Surgical Therapy: Mutual and Combined Aspects

G.Willy Davila

There is no one single clinician who can address all of the problems that may occur in the pelvic floor. In addition, it is not possible to address a problem in one of the compartments of the pelvic floor without potentially affecting its adjacent compartments.This is especially true with the performance of surgical therapy. It is thus of critical importance for the clinician addressing the patient's pelvic floor dysfunction to be keenly aware of the impact that specific treatment may have on adjacent organ systems.

Combined surgical therapy of pelvic floor problems affecting various organ systems at one setting has been demonstrated to be effective and not associated with increased morbidity. Clinicians should be able to operate together during one surgical setting to avoid sequential surgeries and their potential negative impact with prolonged recovery,increased risk of further denervation injury, and scar tissue formation.

Anatomic pelvic floor problems may directly involve two adjacent organ systems. The occurrence of a fistula between any of the three components of the pelvic floor requires an understanding of the impact of the fistula, and its repair, on both (if not all three) involved compartments. We will frequently operate as a team when addressing a complex fistula to prevent increasing dysfunction in one of the compartments during surgical correction of the fistula.

When addressing surgical complications, an understanding of potential dysfunction, which can result from correction of the underlying complication, is also important. This section will emphasize many of the clinical scenarios in which the expertise of multiple clinicians benefit the patient, applied concomitantly, will pelvic floor.

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