2.  An Anterior and Posterior Colporrhaphy is done to repair herniations of the bladder and/or rectum through defects in the vaginal vault.

3.  Difficult Vaginal Births › Multiple Births › Use of forceps during delivery › Perineal tears and episiotomy during delivery  Strain from heavy lifting  Chronic cough or constipation  Weakening of vaginal muscles

4.  Preferred Stirrups  Bovie  Headlamp

5.  Vaginal hysterectomy set  D & C set (if needed)  Basic vaginal set-up  Surgeon-specific sutures and dressings.

6.  Anesthesia › General  Position › Lithotomy  Prep › Vaginal Prep › Indwelling Catheter  Draping › Lithotomy

7.  Transverse incision made at the union of the vaginal mucosa and cervix. › Continued down to pubovesical cervical fascia.  The vaginal mucosa is dissected from the pubovesical and cervical fascia and is opened in the midline until 1 cm-ish from urethral meatus. › Dissection continues until the bladder and urethra are separated from the vaginal mucosa.  Synthetic absorbable sutures placed in the pubovesical and cervical fascia. › Cystocele is reduced.  Excessive vaginal mucosa is removed.  Vaginal mucosa is closed in the midline with interrupted 0 synthetic absorbable sutures.

9.  Allis-Adair clamps are placed on the posterior vaginal mucosa and elevated to create a triangle.  An Allis clamp is placed at the top of the rectocele in the midline. › A transverse incision is made at the posterior fourchette. › Blunt dissection is used to separate the posterior vaginal mucosa from the perirectal fascia.  V-shaped portion of the mucosa is excised as determined by extent of repair required.  Vertical incision is made in the posterior vaginal mucosa and the edges are retracted. › The perirectal fascia is bluntly dissected from the posterior vaginal mucosa.  Rectocele is reduced with finger and levator ani muscles are sutured together.  Closure and dressing

11.  Immediate Post-op Care › Transport to PACU. › Observe color and amount of urine in urine drainage bag.  Prognosis › Return to normal activities.  Complications › Post-op bleeding › Hematoma › UTI › Inability to urinate or stress incontinence › Shortened or narrowed vagina › Rectovaginal fistula › Wound infection › Recurrence of herniation