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PREOPERATIVE DIAGNOSIS: Symptomatic pelvic organ prolapse.

PROCEDURE: Vaginal hysterectomy, bilateral salpingo-oophorectomy, McCall's culdoplasty, anterior colporrhaphy, mid urethral suspension using transobturator tape, cystoscopy, posterior colpoperineorrhaphy.

POSTOPERATIVE DIAGNOSES: Pelvic organ prolapse.

DESCRIPTION OF THE OPERATION AND FINDINGS: Under anesthesia, the cervix protruded 4 cm beyond the introit. There was a cystocele to the introit, a rectocele at -2 cm from the introit. There is gaping of the vagina, loss of the genital hiatus, the vagina permitted 3+ fingers. The uterus was involved with multiple fibroids; some were quite degenerated on the serosal surface. The tubes and ovaries appeared normal.

PROCEDURE: Under satisfactory general anesthesia, the patient was prepped and draped in the dorsal lithotomy position. A circumferential incision was made at the cervicovaginal junction. The bladder is dissected off the lower segment. The ureters were lateralized with dissecting the vaginal mucosa off the cervix. The posterior peritoneum was entered. The uterosacral ligaments are clamped, cut and tied using 0 Vicryl. The cardinal ligaments then are coagulated and cut using Thunderbeat device. The anterior peritoneum was entered. The broad ligaments are separated using Thunderbeat device. Morcellation of the uterus was carried out removing fibroids, enabling cautery of the uteroovarian ligaments, round ligaments, and the tubes. The uterus was brought through. There were adhesions encountered between the fibroid and bowel. These were carefully dissected and removed. Using Thunderbeat device then, the tubes are freed off the pelvic sidewall, the infundibulopelvic ligaments are coagulated and cut. The ovaries were removed bilaterally. A McCall's culdoplasty stitch was used incorporating the uterosacral ligament into the vaginal cuff with closure of the posterior cul-de-sac. The vaginal mucosa was closed in a double layer, first a submucosal stitch, then and a running vaginal mucosa stitch. Anterior colporrhaphy was carried out with dissection of the vaginal mucosa off the bladder. The endopelvic fascia was identified and closed with interrupted 0 Vicryl. The excess vaginal mucosa was excised and the vaginal mucosa is closed. A linear incision is made under the urethra with dissection carried back to the pubic rami using _____ needle. This was passed from the superior medial borders of the obturator foramen into the vaginal incision. Cystoscopic examination is carried out. There is bilateral ejection of indigo carmine, and no bladder injury identified. The tape is brought into position in a tension-free manner. Arms are removed, leaving the tape in position. The vaginal mucosa is then closed with 2-0 Vicryl. Posteriorly, a diamond section of skin is removed from the perineal body and vaginal mucosa. There were scarring at the posterior vaginal mucosa. Dissection is carried out. Interrupted 0 Vicryl was used to close the rectocele. Excess vaginal mucosa is excised. The vaginal mucosa was closed with a running 2-0 Vicryl. The bulbocavernosus muscles are brought to the central tendon of the peritoneum and attached to the superficial transverse peritoneal muscle. The remainder of the repair is done in the usual episiotomy fashion in layers with 2-0 Vicryl. There are no complications of the procedure. Sponge and needle counts correct.

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Help Coding this...Op included