Major Complications of Female Pelvic Surgery: A Multidisciplinary Approach

Foreword
Preface
Acknowledgments
Introduction
Contents
Contributors
Part I: General Perioperative Considerations
1: Perioperative Venous Thromboembolism
	Background
		Epidemiology
		Risk Factors
	Prevention
		Chemoprophylaxis
		Preoperative Chemoprophylaxis
		Timing of Postoperative Chemoprophylaxis
		Mechanical Prophylaxis
		Early Mobilization
		Extended Postoperative Chemoprophylaxis
		Prophylactic IVC Filters
	Diagnosis
		Clinical Assessment and Physical Exam
		Labs and Testing
		Imaging
	Treatment
		Therapeutic Anticoagulation
		Medication Options
		Thrombolysis and Suction Thrombectomy
		IVC Filter Placement
		Duration of Anticoagulation
	References
2: Modern-Enhanced Recovery After Surgery (ERAS) for Major Pelvic Surgery
	The University of Southern California ERAS Protocol
	Preoperative Considerations
	Intraoperative Considerations
	Postoperative Considerations
	Future Directions
		Thromboembolic Events
		Prehabilitation
		Immunonutrition
	Summary
	References
3: Frailty
	Frailty
	Assessing Frailty
	Frailty and Health-Related Outcomes
	Benefits of Frailty Assessment
	Interventions Following Frailty Assessment
	The Role of Geriatricians and Geriatric Care Providers
	Conclusion
	References
4: Nutrition for the Surgical Patient
	Introduction
	Defining Malnutrition and Common Clinical Assessments
	Prevalence of Preoperative Malnutrition in Pelvic Surgery
	General Consequences of Malnutrition in Pelvic Surgery
	Gastrointestinal Anatomic and Functional Alterations that Exacerbate Malnutrition
	(Neo)Adjuvant Therapy
	Perioperative Nutrition and the Gut Microbiome
	Potential Solutions: Evidence for Mitigation of Perioperative Malnutrition
	Conclusions
	References
Part II: Lower Genital Tract
5: Uterine Surgery for Infertility
	Bleeding and Need for Hysterectomy
		Background
		Prevention
		Recognition
		Management
	Formation of Intrauterine Adhesive Disease
		Background
		Prevention
		Recognition
		Management
	Uterine Perforation
		Background
		Prevention
		Recognition
		Management
	Uterine Rupture and Abnormal Placentation
		Background
		Prevention
		Recognition
		Management
	Volume Overload with Hysteroscopic Procedures
		Background
		Prevention
		Recognition
		Management
	Diminished Ovarian Reserve and Loss of Ovary
		Background
		Prevention
		Recognition
		Management
	References
6: Hysterectomy
	Introduction
	Hemorrhage
		Background
		Prevention
		Recognition
		Management
	Bladder Injury
		Background
		Prevention
		Recognition
		Management
	Ureteral Injury
		Background
		Recognition
		Management
	Bowel Injury
		Background
		Prevention
		Recognition
		Management
	Vaginal Cuff Dehiscence
		Background
		Prevention
		Recognition
		Management
	References
7: Genital Tract Prolapse
	Intraoperative Injuries
	Vascular Injury
		Background
		Prevention
		Recognition
		Management
	Urinary Tract Injury
		Background
		Prevention
		Recognition
		Management
	Bowel Injury
		Background
		Prevention
		Recognition
		Management
	Nerve Injury
		Background
		Prevention
		Recognition
		Management
	Postoperative Considerations
	Prolapse Recurrence
	Conclusion
	References
Part III: Lower Urinary Tract
8: Operations for Stress Urinary Incontinence
	Introduction
	Injectable Therapy
		An Overview
		Complications
			Retention
			De Novo Irritative Voiding Symptoms
	Mid-Urethral Slings (MUS)
		An Overview
			Tension-Free Vaginal Tape (TVT)
			Transobturator Tape (TOT)
			Single-Incision Slings (SIS)
		Complications
			Mesh Erosion
			Bladder Injury
			Pain
			Voiding Dysfunction
			De Novo Irritative Voiding Symptoms
			Recurrent Incontinence
	Pubovaginal Slings (PVS)
		An Overview
		Complications
			Bladder Perforation
			Urinary Retention
			De Novo Irritative Voiding Symptoms
			Recurrent Incontinence
	Retropubic Suspensions
		An Overview
		Complications
			Voiding Dysfunction
			Recurrent Incontinence
	Conclusions
	References
9: Urethral Diverticulectomy
	Pathophysiology of a Urethral Diverticulum (UD)
	Prevalence and Presentation
	Diagnosis
	Differential Diagnosis
	Indications for Repair
	Surgical Management
	Excision and Reconstruction
	Complications Following Urethral Diverticulectomy
	Stress Urinary Incontinence
	Concurrent SUI with a Urethral Diverticulum
	De Novo SUI
	Urethrovaginal Fistula
	Urethral Stricture
	Recurrent Urethral Diverticulum
	Conclusions
	References
10: Segmental or Total Female Urethrectomy
	Urethrectomy for Urethral Malignancies
	Urethrectomy for Noncancerous Diseases
	Meatal Stenosis and Distal Urethral Stricture After Partial Urethrectomy
	Meatotomy
	Distal Urethrectomy and Advancement Meatoplasty
	Stress Urinary Incontinence (SUI) After Partial Urethrectomy
	Treatment of Post-Urethrectomy Stress Urinary Incontinence in Women
	Pubovaginal Slings (PVSs)
	Pubovaginal Sling Erosion
	References
11: Transurethral Bladder Surgery
	Introduction
	Bladder Perforation
	Bleeding and Reoperation/Transfusion
	Cystitis: Infection/Urinary Tract Infection (UTI)
	Noninfective Cystitis and Voiding Discomfort
	Summary
	References
12: Partial Cystectomy
	Introduction
	Preoperative Workup
	Surgical Technique
	Partial Cystectomy for Urachal Tumors
	Complications
	Oncological Outcomes
	Conclusions
	References
13: Complications of Radical Cystectomy
	Introduction
	Surgical Approach
	Complications by Category
		Genitourinary
		Infection
		Gastrointestinal
		Cardiopulmonary
		Bleeding/Thromboembolic
		Neurological
			Cerebrovascular Accident/Stroke
			Delirium/Agitation
		Miscellaneous
			Lymphocele
	Unique Complications for Women
		Organ-Sparing Cystectomy (Uterus-, Fallopian Tube-, Ovary-Sparing)
		Ovary Removal Risks (Bone Loss, Fracture Risk, Cardiac Events, Cognitive Decline, Mortality)
		Vaginal Complications
	References
14: Complications in Orthotopic Neobladders
	Introduction
	Early Postoperative Complications
	Long-Term Complications
	Conclusions
	References
15: Continent Cutaneous Urinary Diversion in Women
	Introduction
	History, Techniques, and Outcomes for CCUD Reservoirs
		Ileocecal Reservoirs
		Colonic Reservoirs
		Ileal Reservoirs
	Outcomes, Complications, and Gender
	The Efferent Segment
	The Afferent Segment
	Conclusions
	References
16: Complications of Ileal Conduit Urinary Diversion: A Comprehensive Review
	Introduction
	Stoma-Related Complications
	Parastomal Hernia
	Stomal Stenosis
	Ureterointestinal Stricture
	Infection
	Ileus and Bowel Obstruction
	Enterocutaneous Fistula
	Anastomotic Leak
	Conduit Necrosis
	Metabolic Disturbances
	Sexual Side Effects and Quality of Life Impact
	Additional Thoughts
	References
Part IV: Upper Urinary Tract
17: Injury Repair of Pelvic Ureter
	Background
	Prevention and Evaluation
	Management
	References
18: Ureteroscopy
	Introduction
	Intraoperative Complications
		Ureteral Wall Injury
			Background
			Prevention
			Recognition
			Management
		Ureteral Avulsion and Intussusception
			Background
			Prevention
			Recognition
			Management
		Bleeding
			Background
			Prevention
			Management
		Difficult Access
	Early Postoperative Complications
		Vascular Anomalies
			Background
			Recognition
			Management
		Urinoma, Perirenal Abscess, and Hematomas
		Urinary Infection and Sepsis
			Background
			Prevention
			Recognition
			Management
		Pain and Ureteral Obstruction
		Ureteral Stent Discomfort
		Premature Labor
		Ureteral Stent Migration
			Background
			Prevention
			Recognition
			Management
		Intravascular Stent Misplacement
		Post-Obstructive Diuresis
	Late Postoperative Complications
		Ureteral Strictures
			Background
			Prevention
			Recognition
			Management
		Neglected Stents
			Background
			Prevention
			Recognition
			Management
	Conclusions
	References
Part V: Anus and Rectum
19: Transanal Local Excisions and Endoluminal Approaches
	Introduction
	Perforation
		Background
		Prevention
		Recognition
		Management
	Bleeding
		Background
		Prevention
		Recognition
		Management
	Abscesses
		Background
		Prevention
		Recognition
		Management
	Strictures
		Background
		Prevention
		Recognition
		Management
	Fecal Incontinence
		Background
		Prevention
		Recognition
		Management
	Urinary Retention
		Background
		Prevention
		Recognition
		Management
	References
20: Perianal Abscess and Fistula
	Cryptoglandular Pathophysiology—Abscess
	Fistula-in-Ano
	Treatment Strategies for Fistula-in-Ano
	Fistulotomy
	Seton Placement
	Fistula Plugs/Fibrin Glue
	Ligation of Intersphincteric Fistula Tract (LIFT)
	Endorectal Advancement Flap (ERAF)
	Minimally Invasive Approaches
	Anorectal Fistula Associated with Crohn’s Disease
	Mesenchymal Stem Cell (MSC) Therapy
	Complex Advanced Fistula Therapy
	Conclusions
	References
21: Fecal Incontinence
	Diagnosis and Evaluation of FI
	Treatment
	Anal Insertion Devices
	Vaginal Bowel Control Systems
	Bulking Agents
	Radio-Frequency Tissue Remodeling (SECCA®)
	Percutaneous Tibial Nerve Stimulation (PTNS)
	Sacral Nerve Neuromodulation (SNM)
	Surgical Sphincter Repair (Sphincteroplasty)
	Ventral Mesh Rectopexy (VMR)
	Other Treatments
	References
22: Operations for Rectal Prolapse
	General Background
	Preoperative Procedural Considerations
	Abdominal Procedures for Rectal Prolapse
	General Abdominal Surgery Complications
	Hemorrhagic Complications During Rectopexy
	Mesh Complications
	Discitis
	Intra-Abdominal Collections/Seromas/Abscesses
	Ureteral Injury
	Bowel Obstruction
	Anastomotic Leaks
	Postoperative Pain
	Perineal Surgery
	Multicompartment Prolapse Repairs
	Postoperative Constipation/Fecal Impaction
	Conclusions
	References
Part VI: Miscellaneous
23: Complications of Minimally Invasive Surgery
	Trocar Injury: Vascular and Bowel Injuries
		Background
		Prevention
		Recognition
			Vascular Injury
			Bowel Injury
		Management
			Major Vascular Injury
			Carbon Dioxide Embolism
			Bowel Injury
	Surgical Energy and Thermal Injury
		Background
		Recognition
		Management and Prevention
	Incision Site Hernia
		Background
		Recognition
		Management and Prevention
	Considerations for Obesity
		Respiratory Mechanics
		Preoperative Evaluation
		Positioning
	Trendelenburg Complications
		Cardiopulmonary
		Ocular Complications
		Peripheral Nerve Injury
	References
24: Composite Pelvic Resection for Deeply Infiltrating Endometriosis
	Background
		Diagnosis
		Treatment
		Goals of Treatment
		The General Surgical Approach
		Nerve-Sparing Surgery
	Approach to Urologic Endometriosis
		Bladder Endometriosis
			Diagnosis
			Treatment
		Ureteral Endometriosis (UE)
			Diagnosis
			Treatment
		Ureteral Complications
	Approach to Gastrointestinal Endometriosis
		Diagnosis
		Surgical Treatment
			Shaving Excision
			Laparoscopic Disk Excision
			Segmental Resection
	Bowel Complications
	Conclusions
	References
25: Inflammatory Bowel Disease
	Introduction
	Intraoperative Complications
		Injury to the Ureter and Bladder
		Injury to the Reproductive Organs
		Injury to the Vessels
	Early Postoperative Complications
		Surgical Site Infections
		Anastomotic/Pouch Leaks and Pelvic Abscesses
	Late Postoperative Complications
		Anastomotic/Pouch Fistulas
		Infertility
		Sexual Dysfunction
		Unhealed Perineal Wound
		Entrapped Ovary (Inclusion Cyst)
	Summary
	References
26: Complications of Resection of Retroperitoneal Tumors in the Female Pelvis
	Introduction
		Tumors of the Female Pelvis
	Complications of Resection of Non-gynecologic Tumors in the Female Pelvis
	Genitourinary Complications
		Background
		Prevention
		Recognition
		Management
	Urinary Tract
		Background
		Prevention
		Recognition
		Management
	Bladder Injury
		Background
		Prevention
		Recognition
		Management
	Vascular Injury
		Background
		Prevention
		Recognition
		Management
	Neurologic Injury
		Background
		Prevention
		Recognition
		Management
	References
Part VII: Pregnancy
27: Cesarean Section
	Introduction
	Postpartum Hemorrhage
		Background
		Prevention
		Recognition
		Management
	Unintended Hysterotomy Extension
		Background
		Prevention
		Recognition
		Management
	Uterine Scar Dehiscence
		Background
		Prevention
		Recognition
		Management
	Uterine Inversion
		Background
		Prevention
		Recognition
		Management
	Bladder and Bowel Injury
		Background
		Prevention
		Recognition
		Management
	Post-Cesarean Infection
		Background
		Prevention
		Recognition
		Management
	References
28: Management of Ectopic Pregnancy and Surgical Considerations
	Background
	Tubal Ectopic Pregnancy
		Prevention
			Avoidance of Surgery with Medical Management
			Selection of Appropriate Surgical Candidates
			Bleeding, Infection, and Damage to Surrounding Structures
			Laparoscopy Versus Laparotomy
		Recognition
			Massive Hemorrhage, Hemodynamic Instability
			Laparoscopic Entry and Complications
			Nondiagnostic Laparoscopy
		Management
			Hemoperitoneum
			Choice of Salpingectomy Versus Salpingotomy
	Nontubal Ectopic Pregnancy
		Prevention
		Recognition
		Management
			Interstitial
			Ovarian
			Cervical and Cesarean Scar
	References
29: Surgical Abortion
	Introduction
	Hemorrhage
		Uterine Atony
			Background
			Prevention
			Recognition
			Management
		Abnormal Placentation
			Background
			Prevention
			Recognition and Management
		Acute Coagulopathy
			Background
			Prevention
			Recognition
			Management
	Cervical Injury
		Background
		Prevention
		Recognition
		Management
	Uterine Injury
		Background
		Prevention
		Recognition
		Management
	Infection
		Background
		Prevention
		Recognition
		Management
	Retained Products of Conception
		Background
		Prevention
		Recognition and Management
	Conclusions
	References
30: Cesarean Hysterectomy
	Introduction
	Complications of Simple Cesarean Hysterectomy
		Obstetric Hemorrhage
			Background
			Prevention
			Recognition
			Management
		Surgical Site Infection
			Background
			Prevention
			Recognition
			Management
	Cesarean Hysterectomy with Placenta Accreta Spectrum (PAS)
		Massive Obstetric Hemorrhage
			Background
			Prevention
			Recognition
			Management
		Disseminated Intravascular Coagulopathy (DIC)
			Background
			Prevention
			Recognition
			Management
		Urologic Injury
			Background
			Prevention
			Recognition
			Management
	References
Part VIII: Cancer
31: Inguinal Lymphadenectomy, Radical Vulvectomy
	Background of Lymphedema After Inguinofemoral Lymphadenectomy
	Recognition of Lymphedema Following Inguinofemoral Lymphadenectomy
	Prevention of Lymphedema Following Inguinofemoral Lymphadenectomy
	Management of Lymphedema Following Inguinofemoral Lymphadenectomy
	Background of Infectious Morbidity Following Radical Vulvectomy and Inguinofemoral Lymphadenectomy
	Recognition of Infectious Morbidity Following Radical Vulvectomy and Inguinofemoral Lymphadenectomy
	Prevention of Infectious Morbidity Following Radical Vulvectomy and Inguinofemoral Lymphadenectomy
	Management of Infectious Morbidity Following Radical Vulvectomy and Inguinofemoral Lymphadenectomy
	Background of Functional Impairments After Radical Vulvectomy
	Recognition of Functional Impairments After Radical Vulvectomy
	Prevention of Functional Impairments After Radical Vulvectomy
	Management of Functional Impairments After Radical Vulvectomy
	References
32: Pelvic and Paraaortic Lymphadenectomy
	Introduction
	Vascular Injury
		Background
		Prevention
		Recognition
		Management
	Lymphedema
		Background
		Prevention
		Recognition
		Management
	Nerve Injury
		Background
		Prevention
		Recognition
		Management
	Ureteral Injury
		Background
		Prevention
		Recognition
		Management
	Disruption of the Mesentery
		Background
		Prevention
		Recognition
		Management
	Duodenum
		Background
		Prevention
		Recognition
		Management
	Arterial Embolization
		Background
		Prevention
		Recognition
		Management
	Lymphocyst and Chylous Ascites
		Background
		Prevention
		Management
	References
33: Radical Hysterectomy
	Introduction
	Ureteral Injury
		Background
		Prevention
		Recognition
		Management
	Bladder Injury
		Background
		Prevention
		Recognition
		Management
	Rectal Injury
		Background
		Prevention
		Recognition
		Management
	Bladder Dysfunction
		Background
		Prevention
		Recognition
		Management
	Colorectal Dysfunction
		Background
		Prevention
		Recognition
		Management
	Vaginal Dehiscence and Evisceration
	Surgical Site Infection
		Background
		Prevention
		Recognition
		Management
	Sexual Dysfunction
		Background
		Prevention
		Recognition
		Management
	References
34: Composite Pelvic Resection for Ovarian Cancer
	Vascular Injury
		Background
		Prevention
		Recognition
		Management
	Post-Operative Bleeding/Hematoma
		Background
		Prevention
		Recognition
		Management
	Urinary Tract Injury
		Background
		Prevention
		Recognition
		Management
	Anastomotic Leak
		Background
		Prevention
		Recognition
		Management
	Bowel Injury
		Background
		Prevention
		Recognition
		Management
	Anastomotic Bleeding
		Background
		Prevention
		Recognition
		Management
	Anastomotic Stricture
		Background
		Prevention
		Recognition
		Management
	References
35: Anal Cancer
	Introduction
	Complications of Local Excision
	Complications of Radical Surgery Performed for Persistent or Recurrent Disease
		Perineal Wound Infection/Dehiscence
			Background
			Prevention
			Recognition
			Management
				Acute
				Chronic
		Pelvic Fluid Collections/Abscesses/Organ Space Infections
			Background
			Prevention
			Recognition
			Management
		Perineal Hernia
			Background
			Prevention
			Recognition
			Management
		Small Bowel Obstruction
			Background
			Prevention
			Recognition
			Management
	Complications of Primary Disease
		Large Bowel Obstruction
			Background
			Prevention
			Recognition
			Management
		Fecal Incontinence
			Background
			Prevention
			Recognition
			Management
		Rectovaginal Fistula
			Background
			Prevention
			Recognition
			Management
	Complications of Therapy (Chemoradiation)
		Radiation Enteritis
			Background
			Prevention
			Recognition
			Management
		Sigmoid Stricture Formation
			Background
			Prevention
			Recognition
			Management
	Conclusion
	References
36: Rectal and Rectosigmoid Carcinoma
	Introduction
	Anastomotic Leak
		Background
		Prevention
		Recognition
		Management
			AL Requiring Operative Intervention
				Endosponge
				Local Repairs
				Marsupialization of the Sinus Tract
			Nonoperative Management of AL
	Anastomotic Stricture
		Background
		Prevention
		Recognition
		Management
	Anastomotic Bleeding
		Background
		Prevention
		Recognition
		Management
	Presacral Venous Bleeding
		Background
		Recognition
		Prevention
		Management
	Low Anterior Resection Syndrome
		Background
		Prevention
		Recognition
		Management
	Sexual and Urinary Dysfunction
		Background
		Prevention
		Recognition
		Treatment
	References
37: Pelvic Radiation Therapy
	Introduction
	A Brief Primer on Radiation Therapy
		External Beam Radiation Therapy
		Brachytherapy
	Radiotherapy Toxicity
	Toxicities by System
		Bladder/Ureters/Urethra
			Background
			Possible Effects
			Prevention
			Recognition
			Management
		Small Bowel
			Background
			Possible Effects
			Prevention
			Recognition
			Management
		Colon/Rectum
			Background
			Possible Effects
			Prevention
			Recognition
			Management
		Anus/Vulva/Skin
			Background
			Possible Effects
			Prevention
			Recognition
			Management
		Uterus
			Background
			Possible Effects
			Prevention
			Recognition
			Management
		Ovaries
			Background
			Possible Effects
			Prevention
			Recognition
			Management
		Vagina
			Background
			Possible Effects
			Prevention
			Recognition
			Management
		Vascular/Lymphatics/Nerves
			Background
			Possible Effects
			Prevention
			Recognition
			Management
	References
38: Pelvic Exenteration for Central Pelvic Cancer
	Introduction
	Assessment and Anticipation of Surgical Complications
		Pre-Operative Considerations
		Intra-Operative Complications
			WHO Checklist
				Specific Intra-Operative Considerations: Urology
				Specific Intra-Operative Considerations: Colorectal
				Specific Considerations: Plastic and Reconstructive (See Chap. 41)
		Post-Operative Complications
			Immediate
	Early Complications—First 6 Weeks After Surgery
	Delayed Complications—In the First 12 Months
	Long-Term Beyond 12 Months
	Conclusion
	References
39: Resection of Recurrent Pelvic Sidewall Tumor
	Introduction
	Bowel Injury and Complications
		Background
		Prevention
		Recognition
		Management
	Urinary Tract Injury and Complications
		Background
		Prevention
		Recognition
		Management
	Vascular Injury and Complications
		Background
		Prevention
		Recognition
		Management
	Nerve Injury and Complication
		Background
		Prevention
		Recognition
		Management
	Summary
	References
40: Resection of Tumors Involving the Pelvic Girdle
	Nerve Injury
		Background
		Prevention
		Recognition
		Management
	Vascular Injury
		Background
		Prevention
		Recognition
		Management
	Unique Considerations in Sacral Resections
		Background
		Prevention
		Recognition
		Management
	Fractures of the Pelvic Ring and Acetabulum
		Background
		Prevention
		Recognition
		Management
	Hardware Failure/Mechanical Complications
		Background
		Prevention
		Recognition
		Management
	Pelvic Cancer Complications Involving Bone
		Osteomyelitis
			Background
			Prevention
			Recognition
			Management
	Radiation Complications of Pelvic Bone
		Radiation Osteitis
	Recurrent and Metastatic Lesions
		Background
		Prevention
		Recognition
		Management
	Radiation Associated Sarcomas
		Background
		Prevention
		Recognition
		Management
	Wound Healing Considerations
		Background
		Prevention
		Recognition
		Management
	References
41: Pelvic Reconstructive Procedures
	Background
	Prevention
	Preoperative
	Intraoperative
	Postoperative
	Recognition
		Wound Dehiscence and Delayed Wound Healing
		Fluid Collection
		Infection
		Partial or Total Flap Loss
		Fistula
		Donor Site Complications
	Management
		Wound Dehiscence and Delayed Wound Healing
		Fluid Collection
		Infection
		Partial or Total Flap Loss
		Fistula
		Donor Site Complications
	Conclusion
	References
Index