Gyn Surgical Complications

Question 1

Rectovaginal fistule

Answer 1

Confirm on exam by putting methylene blue dye in exam gel and performing rectal exam

Refer to specialist

Specialist will excise fistula trace and repair in non-overlapping layers (3)

Stool softeners, sits baths and 5 days abx recommended

Question 2

Uro-vaginal fistula DDX

Answer 2

Vesicovaginal fistula
Uretrovaginal fistula
Disruption of vaginal Apex closure (dehiscence)
Uroma drainage

Question 3

How to confirm site of Urovaginal fistula

Answer 3

Tampon test
Cystoscopy
IV pyelogram

Question 4

How to repair a vesicovaginal fistula

Answer 4

Foley catheter 4 to 6 weeks. If spontaneous healing does not occur,

Three layer closure after excision of tract:
Bladder submucosal layer
Bladder muscularis
Vaginal mucosa

Question 5

Repair of ureterovaginal fistula

Answer 5

Lower ureter
Ureteral stents (30% heal in 4 wks)
If that doesn’t work,
Ureteroneocystotomy and 
IVP at 3,6,12 months

High ureteral injury
Percutaneous nephrostomy
Ureteral reimplantation at 12 weeks after mobilizing bladder
IVP AT 3,6,12 mo

Question 6

SIRS

Answer 6

At least 2:

38 deg Celsius
HR >90
WBC >12000
RR >20

Question 7

Surviving sepsis campaign goals

Answer 7

CVP 8-12 mmHg
MAP >65 mmHg
UOP> 0.5 mL/kg/hr
BS 120-150

Question 8

Ilioinguinal and iliohypogastric nerve injuries

Answer 8

Sensory only
Pain radiating from incision to suprapubic area, symphysis, labia major
T12-L1

Question 9

Femoral nerve injury

Answer 9

L2-4
Large self retaining retractor
Motor loss: quadriceps
Sensory loss anterior medial leg and thigh

Question 10

Peroneal nerve injury

Answer 10

L4-S2
Motor only: foot drop and inversion


Question 11

Sciatic nerve injury

Answer 11

L4-S3
They have an incomplete flexion of the knee
Motor only: Weak hamstrings and leg flexion

Question 12

How to manage ureteral injury is recognized intraop

Answer 12

<5 cm from UVJ, ureteroneocystomy w stent placement 10-14 days. IVP after repair and 8-12 wks postop
24 cm, 6Fr stent

Higher injuries: end to end reanastomosis