Checklist for Posterior and Anterior Colporraphy

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This checklist is part of the Gynsurgery guidelines used in an educational setting for residents in Ob-Gyn.

The pdf form of the Checklist for Posterior and Anterior Colporraphy may not reflect the latest changes

Preoperative Checklist

(Please indicate    - Done,   X - Not done,   NA – Not applicable)
  1. ___ Screen for bacterial vaginosis and treat patients if positive (prevent vaginal infection)
  2. ___ Evaluate patient for anterior paravaginal defect and if present include or change to a paravaginal repair
  3. ___ Identify any vault descensus and if present, include procedure to suspend the vaginal apex
  4. ___ Inform patient and sign consent for possible complications: bleeding, bladder injury, rectal injury, infection, pelvic pain, granulation tissue, postoperative vault prolapse, cystocele or rectocele recurrence, back pain, dyspareunia , and continued incisional/pelvic pain (prevent unreasonable expectations of surgery)
  5. ___ Recommend to clip perineal hair prior to surgery but no shaving (prevent infection)
  6. ___ Order mechanical bowel prep for the day before surgery (prevent wound separation)
  7. ___ Order prophylactic antibiotics, at least 30-60 minutes before incision and consider repeating antibiotics (up to three doses) for high risk patients (prevent vaginal abscess)
  8. ___ Discontinue ASA (5 days), Plavix (3 days) and other anti-clotting medications prior to surgery ) (prevent bleeding)

Intraoperative Checklist

  1. ___ Use Allen stirrups for positioning rather than candy cane stirrups (prevent low back pain)
  2. ___ Avoid hyperelevation of legs (prevent low back pain, prevent nerve injury)
  3. ___ Inject under vaginal mucosa with a pitressin solution (10-20U/100ccNS) (prevent bleeding)
  4. ___ Keep urine in bladder (clamp foley) during procedure in order to recognize and repair any incidental cystotomy incision (prevent vesicovaginal fistula)
  5. ___ Dissect with metzenbaum scissors curved away from bladder muscularis toward the vaginal muscularis (prevent bladder injury)
  6. ___ Dissect with metzenbaum scissors curved away from rectal muscularis toward the vaginal muscularis (prevent rectal injury)
  7. ___ Avoid removing too much mucosa (too wide) and narrowing the vaginal aperature (prevent dyspareunia)
  8. ___ Avoid removing too much mucosa (too high toward cuff) and shortening the vagina (prevent dyspareunia)
  9. ___ Excise vaginal mucosa/attenuated muscularis over rectocoele laterally to ruggated vaginal mucosa/muscularis (prevent post procedure recurrence of cystocoele or rectocele)
  10. ___ Avoid cautery use on rectal muscularis (prevent rectal vaginal fistula)
  11. ___ Use rapidly absorbing suture material (chromic catgut, Monocryl) (to prevent granulomas, prevent dyspareunia)
  12. ___ Suture vaginal muscularis and mucosa together without including bladder or rectal muscularis (prevent suture in bladder/rectum)
  13. ___ Avoid placing sutures in levator ani muscles (prevent post operative persistent pain)
  14. ___ Avoid leaving knot(s) at hymeneal ring of introitus (prevent dyspareunia)
  15. ___ Avoid using permanent mesh in repair if possible (prevent vaginal granulation tissue)
  16. ___ Avoid stool contamination of incision or needles (prevent incision infection)
  17. ___ Avoid excessive tension on vaginal suture lines with a vaginal pack if used (prevent incision dehissence/separation)

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