Checklist for Posterior and Anterior Colporraphy

= Checklist for Posterior and Anterior Colporraphy = (pdf checklist 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 muscularis (prevent suture in bladder)
 * 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)