Reoperative Pelvic Surgery

Reoperative Pelvic Surgery

Preface

Contents

Contributors

Introduction and Overview: Principles of Reoperative Pelvic Surgery

Pelvic Anatomy

Timing of Reoperation

Patient Preparation

Conduct of the Surgery

Other Points to Consider During Surgery

Identification of Structures

Rectal Stump

Vaginal Identification

Prevention and Control of Pelvic Bleeding

Management of Bleeding

Specific Procedures and Reconstruction

Conclusion

References

Reoperations Within the First 30 Days After Pelvic Surgery

Anorectal Complications

Infection

Wound Healing Complications

Fecal Impaction

Reoperative Pelvic and Abdominal Complications

Infection

Wound and Fascial Dehiscence

Anastomotic Leak

Small Bowel Obstruction

Fistulous Complications

Early Stoma Complications

Postoperative Cholecystitis

Ureteral Injury

Compartment Syndrome

References

Reoperation and Management of Postoperative Pelvic Hemorrhage and Coagulopathy

Etiology

Incidence

Diagnosis

Coagulopathy

Acquired Platelet Dysfunction

Acquired Coagulopathy

Decision to Reoperate

Transcatheter Arterial Embolization

Reoperative Techniques

Space-Specific Surgical Techniques

Presacral Space

Obturator Fossa

Space of Retzius

Pelvic Floor

Abdominal Packing

Conclusion

References

Reoperative Considerations After Laparoscopic Pelvic Surgery

Expected Postoperative Course

Evaluation of Patients Who Deviate from the Expected Postoperative Course

Clinical Signs and Symptoms

Laboratory Studies

Radiologic Evaluation

Laparoscopic Management of Postoperative Complications

Postoperative Bleeding

Bowel Obstruction

Trocar Site Hernias

Adhesive Obstructions

Infectious Complications

Missed Enterotomies

Anastomotic Dehiscences

Pelvic Abscesses

Conclusion

References

Laparoscopic Reoperative Surgery for Incompletely Staged Gynecologic Malignancies

Endometrial Carcinoma

Ovarian Carcinoma

Cervical Carcinoma

Laparoscopic Lymphadenectomy Technique

Robotic Reoperative Surgery and Lymphadenectomy

Conclusion

References

Reoperation for Endometriosis and Ovarian Remnants

Endometriosis

Treatment

Recurrence

Complications of Surgery

Rectal Involvement with Endometriosis

Ovarian Remnant Syndrome

Diagnosis

Physical Examination

Management

References

Pelvic Exenteration for Recurrent Pelvic Cancer

Patient Selection

Counseling

Perioperative Management

Surgical Techniques

Exploratory Laparotomy

Periaortic Lymphadenectomy

Pelvic Lymphadenectomy and Assessment of Resectability

Abdominal Exenterative Phase

Perineal Exenterative Phase

Reconstructive Phase: Conduit Formation

Vaginal Reconstruction

Postoperative Care

Postoperative Complications

References

Reoperation for Bladder Cancer

Nephroureterectomy for Upper Tract Recurrence After Cystectomy

Surveillance

Risk Factors

Treatment

Nephron-Sparing Techniques

Open Nephroureterectomy

Operative Technique: Open Nephroureterectomy After Radical Cystectomy and Ileal Conduit Diversion

Complications

Survival Outcomes

Urethrectomy for Urethral Recurrence After Cystectomy

Presentation

Risk Factors

Surveillance

Treatment

Conservative Therapy

Urethrectomy

Operative Technique: Urethrectomy After Radical Cystectomy

Male Patients with Ileal Conduit Diversion

Male or Female Patients with Orthotopic Neobladder Diversion

Total Urethrectomy with Conversion to Incontinent Cutaneous Diversion

Subtotal Urethrectomy with Perineal Urethrostomy

Complications

Survival

Completion Cystectomy for Recurrence After Partial Cystectomy

Patient Selection

Operative Technique of Completion Cystectomy

Treatment Outcomes

Pelvic Recurrence

Risk Factors

Presentation

Treatment

Treatment Outcomes

Operative Techniques for Pelvic Recurrence

Conclusion

References

Reoperative Surgery for Prostate Cancer

Radical Prostatectomy After Surgery for Benign Prostatic Hyperplasia

Technical Challenges

Oncologic Outcomes

Complications and Functional Outcomes

Timing and Technical Modifications

Surgery After Failed Local Therapy

Salvage Radical Prostatectomy

The Role of PSA in Salvage Radical Prostatectomy

Morbidity

Predictors of Survival

Oncologic Outcomes After Salvage Radical Prostatectomy

Functional Outcomes

Technical Challenges and Surgical Modification

Salvage Radical Surgery for Bulky Local Recurrence After Radical Prostatectomy

References

Introduction to Reoperative Pelvic Surgery for Rectal Cancer

Risk Factors and Prevention

Prognostic Factors

Management of Recurrent Rectal Cancer

Phase 1

General Evaluation, Risk Assessment, and Initial Staging

Determining Resectability

Phase 2

Preoperative Multimodality Treatment

Phase 3

Surgical Resection and Intraoperative Radiotherapy

Surgical Resection

MSKCC Experience

Intraoperative Radiotherapy

Palliative Therapy for Advanced Recurrent Rectal Cancer

Summary: Reoperative Treatment of Locally Recurrent Rectal Adenocarcinoma

Recurrent Squamous Cell Carcinoma of the Anus

References

Recurrent Pelvic Organ Prolapse

Risk Factors Associated with Prolapse

Anatomy and Pathology

Surgical Management of Apical Prolapse

Apical Prolapse Using Uterosacral Ligaments

McCall Culdeplasty

Uterosacral Vaginal Vault Suspension

Sacrospinous Ligament Fixation

Iliococcygeus Vaginal Vault Suspension

Abdominal Sacrocolpopexy

Tension-Free Vaginal Mesh Kit Procedures

Obliterative Procedures

Colpectomy and Le Fort Colpocleisis Procedures

Anterior Wall Prolapse

Anterior Colporrhaphy

Paravaginal Repair

Graft Augmentation

Posterior Wall Prolapse

Posterior Colporrhaphy

Site-Specific Defect Repair

Graft Augmentation

Sexual Function and Posterior Repair

Conclusion

References

Recurrent Rectal Prolapse

Etiology

Symptoms and Physical Findings

Evaluation

Choice of Operative Repair

Operative Technique: Abdominal Approach

Rectopexy

Resection and Rectopexy

Operative Technique: Perineal Approach

Delorme

Perineal Proctectomy

Conclusion

References

Suburethral Sling Failures and Complications

Evaluation of Sling Failures

Recurrent Stress Urinary Incontinence After Sling

Complications of Slings

Visceral Perforation

Bleeding

Bladder and Urethral Perforation

Voiding Dysfunction

Urethral Erosion

Vaginal Erosion/Extrusion

Infection and Abscess

Obstruction

Evaluation And Intervention

Treatment

Incision of Sling

Urethrolysis

Conclusion

References

Reoperative Surgery for Anal Incontinence

Redo Anterior Sphincteroplasty

Postanal Repair

Gluteoplasty

Graciloplasty

Sacral Nerve Stimulation

Artificial Bowel Sphincter

Gynecologic Approaches to Fecal Incontinence

Bias Toward Obstetrical Surgical Experience

Lack of Experience with Sonographic and Functional Assessment Tools

Absence of Colorectal Expertise in Many Communities

Reparative Surgery

Alternate Surgical Approaches

Colostomy

Conclusion

References

Gastrointestinal Fistulas

Rectourinary Fistulas

York Mason Approach to Genitourinary Fistulas

Clinical Scenario

Preparation and Position

Incision

Fistula Repair

Postoperative Care

Perineal Approach to Rectoprostatic Fistulas

Clinical Scenario

Preparation and Position

Incision

Dissection

Fistula Repair

Postoperative Care

Rectovaginal Fistulas

Clinical Scenario

Definition

Obstetrical Trauma

Crohn’s Disease

Operative Trauma

Radiation and Cancer

Evaluation

Transanal Flap Repair

Traumatic Cloaca Repair

Preparation

Incision

Repair

Postoperative Care

Other Techniques Used for Complex Rectovaginal Fistulas

Vesicoenteric Fistulas

Colovesical

Diverticular Colovesical Fistula

Malignant Enterovesical Fistula

Rectovesical Fistulas

Rectovesical Fistula in a Hostile Pelvis: Repaired Using a Transcystic Approach

Enterocutaneous Fistulas

Etiology

Management of Enterocutaneous Fistulas

Resuscitation

Investigation

Surgical Management

Fistula in Ano

Clinical Scenario

Definition

History

Inspection

Palpation

Anoscopy and Proctosigmoidoscopy

Natural History of Fistula-in-Ano

Imaging

Management

Fistulotomy

Fibrin Glue Injection

The Role of Setons

Cutting Setons

Drainage Setons

Long-Term Drainage Setons

Short-Term Drainage Setons

Marking Setons

Dermal Advancement Flaps

Transanal Anorectal Advancement Flap

Fistulectomy and Primary Closure

Anal Fistula Plug

Fistula and Carcinoma

Fistula in Crohn’s Disease

Fistula in Infants

Recurrent Anal Fistula

References

Urogenital Fistulas

Etiology and Epidemiology of Urogenital Fistulas

Vesicovaginal Fistula

Surgical VVF

Obstetric VVF

Radiation VVF

Other VVF

Urethrovaginal Fistula

Vesicouterine Fistula

Ureterouterine Fistula

Ureterovaginal Fistula

Evaluation and Diagnosis of Urogenital Fistulas

Presentation

Physical Examination

Cystoscopy

Imaging

Urodynamics

Surgical Principles of Fistula Prevention

Management of the Vesicovaginal Fistula

Conservative Management

Surgical Repair: General Principles

Timing of Repair

Preoperative Issues

Surgical Repair: Minimally Invasive Approaches

Sealants

Thermal Ablation

Cystoscopic Intervention

Surgical Repair: Open Techniques

Surgical Principles

Abdominal Versus Vaginal Approach

Transabdominal Technique for Vesicovaginal Fistula Repair

Transvaginal Technique for Vesicovaginal Fistula Repair

Surgical Outcomes Following Open Repair of Vesicovaginal Fistula

Open Versus Laparoscopic Approach

Surgical Repair, Tissue Interposition

Martius Flap

Peritoneal Flap

Omental Flap

Muscular Flaps

Postoperative Issues

Management of Additional Urogenital Fistulas

Urethrovaginal Fistula

Vesicouterine Fistula

Ureterouterine Fistula

Ureterovaginal Fistula

Conclusion

References

Complications of Urinary Diversion

History

Complications

Metabolic Derangements

Nutritional Abnormalities

Metabolic Consequences

Ileum

Jejunum

Colon

Osteomalacia

Drug Reabsorption

Urolithiasis

Pyelonephritis

Stomal Complications

Parastomal Hernias

Ureterointestinal Anastomotic Complications

Bowel Complications

Renal Function

Secondary Neoplasm

References

Complications of Transurethral Surgery

Transurethral Resection of the Prostate

Intraoperative Complications

Bleeding

Transurethral Resection Syndrome

Prostatic Capsule Perforation

Injury to the Ureteral Orifices

Injury to the External Sphincter

Postoperative Complications

Failure to Void/Urinary Retention

Hematuria

UTI and Epididymitis

Irritative Voiding Symptoms

Late Postoperative Complications

Urinary Incontinence

Urethral Stricture and Bladder Neck Contracture

Ejaculatory Dysfunction

Erectile Dysfunction

Retreatment

Transurethral Resection of Bladder Tumor

Hemorrhage

Bladder Perforation

Other Concerns

Conclusion

References

Reoperative Management of Fissure and Hemorrhoids

Anal Fissure

Definition and Epidemiology

Etiology

Management

Medical Management

Nitrates

Calcium Channel Blockers

Botulin Toxin

Surgical

Anal Dilatation

Sphincterotomy

Fissurectomy

Anal Advancement Flaps

Summary

Anal Stenosis

Definition and Epidemiology

Etiology

Management

Nonoperative

Surgical

Mucosal Advancement Flaps

V-Y or Y-V Advancement Flap

Diamond or House Flap

Rotational S-Plasty

Summary

Recurrent Hemorrhoidal Disease

Rate of Recurrent Hemorrhoidal Disease

Management of Recurrent Disease

Summary

References

Reoperative Surgery for Inflammatory Bowel Disease

Crohn’s Disease

Small Bowel Disease

Surgery

Colonic Disease

Surgery

Technique of Rectal Resection

Perineal Resection of the Anus and Distal Rectum

Perianal Disease

Reoperative Surgery for Crohn’s Disease

Recurrent Disease

After Ileocolectomy

After Segmental Colectomy

After Small Bowel Resection or Stricturoplasty

Specific Complications

Anastomotic Dehiscence/Fistula

Anastomotic Stricture

Presacral Hemorrhage

Pelvic Abscess

Perineal Hernia

Cancer

Unhealed Perineal Wound

Chronic Ulcerative Colitis

Total Proctocolectomy and Standard (Brooke) Ileostomy

Reoperations Following Total Proctocolectomy

Delayed Perineal Wound Healing

Stoma Problems

Subtotal Colectomy and Ileorectal Anastomosis

Specific Complications

Anastomotic Leakage

Continuing Proctitis/Dysplasia

Secondary Proctectomy

Total Proctocolectomy and Continent Ileostomy

Complications of Continent Ileostomy

Early Postoperative Complications

Hemorrhage

Suture Line Dehiscence

Early Fistulas

Ischemia

Ischemia of the Outflow Tract

Ischemic Necrosis of the Valve

Late Complications

Valve Slippage

Valve Revision

Valve Repair

Valve Reconstruction

Late Fistulas

Repair of Valve Fistula

Skin-Level Stenosis

Double Z-Plasty

Valve Prolapse

Repair of Valve Prolapse

Restorative Proctocolectomy

Restorative Proctocolectomy Complications

Pelvic Sepsis

Pouch Ischemia

Pouch Suture Line Leak

Pelvic Abscess

Ileal Pouch-Anal Anastomosis Leak

Ileal Pouch-Anal Anastomosis Perineal Fistula

Transanal Ileal Advancement

Pouch Advancement

Fibrin Sealant/Anal Fistula Plug

Pouch Vaginal Fistula

Transanal Repair

Transvaginal Repair

Pouch Advancement

Interposition Flap

Pouch Redo

Secondary Mucosectomy

Ileal Pouch-Anal Anastomosis Stricture

Obstructed Defecation/Pouch Prolapse

Cancer Following Restorative Proctocolectomy

Pouch Excision

References

Complications of Surgery After Pelvic Radiation

General Principles of Radiation Therapy

Radiation Therapy Techniques

Acute and Late Toxicities by Organ with Pathophysiology

Rectum

Bladder

Ureters

Reducing Incidental Radiation

Complications of Surgery After Pelvic Radiation

Salvage Prostatectomy

Surgical Considerations of Salvage Prostatectomy

Salvage Cystectomy

Urinary Diversion

Surgical Considerations of Salvage Cystectomy

Surgical Considerations After Radiation for Cervical Carcinoma

Conclusion

References

Reoperation for Diverticular Disease

Re-Resection for Recurrent Diverticulitis After Previous Colon Resection

Reoperation After a Previous Hartmann’s Procedure

Conclusion

References

Reoperative Surgery for Gastrointestinal Stomal Problems

Stomal Complications and Risk Factors

Emergent Versus Elective Stoma Creation

Ischemia and Necrosis

Prolapse

Retraction

Stenosis

Parastomal Hernia

Symptoms

Diagnosis

Nonoperative Therapy

Surgical Repair

Operative Techniques

Local Repair with Sutures

Parastomal Subcutaneous Repair

Onlay Mesh Repair

Relocation

Intraabdominal Mesh Repairs

Laparoscopic Repair

Abdominoplasty and Contouring

Loop Ostomy Hernias

Results of Parastomal Hernia Repair

Summary of Parastomal Hernias

Bleeding and Peristomal Varices

Trauma and Perforation

Abscess and Fistula

Obstruction

Parastomal Pyoderma Gangrenosum

Miscellaneous Problems

Mucosal Implantation

Fungal Infections

Allergic Reactions

High-Output Ostomy and Dehydration

Stomal Polyps and Carcinoma

Conclusion

References

Reoperative Pelvic Surgery for Late Bowel Obstruction (After 30 Days)

Differential Diagnosis and Diagnostic Workup

Preoperative Considerations

Distorted Anatomy and Loss of Normal Tissue Planes

Potential Pitfalls and Complications

Preoperative Adjuncts

Operative Technique

Specific Situations and Management

Malignant Bowel Obstruction from Local Recurrence or Carcinomatosis

Reversal of Hartmann’s/Stoma Closure

Gynecologic Malignancy

Conclusion

References

Suggested Readings

Reoperations for Bleeding

Gastrointestinal Bleeding

Etiologies

Initial Assessment, Resuscitation, and Stabilization

Radionuclide Imaging

Colonoscopy

Angiography

Newer Diagnostic Methods

Operative Therapy

Perioperative Hemorrhage

Preoperative Preparation

Intraoperative Considerations

Splenic Injury

Pelvic Hemorrhage

Laparoscopic Surgery

Anastomotic Hemorrhage

Anorectal Procedures

Postoperative Care

Postoperative Hemorrhage

Conclusion

References

Reoperative Surgery for Constipation or Dysmotility

Always Start Over with the History

Physical Examination

Further Testing

Conservative Treatment

Surgical Treatment

Slow Transit Constipation

Obstructed Outlet Defecation

Conclusion

References

Index