All posts by Madeline Verbica

PUBLISHED: Site-Specific Posterior Colporrhaphy and Perineorrhaphy for Rectocele

Site-Specific Posterior Colporrhaphy and Perineorrhaphy for Rectocele

Lori R. Berkowitz, MD
Mass General Hospital

Patricia L. Hudson, MD
Massachusetts General Hospital

This patient is a 38-year-old female who presented with fecal incontinence, constipation, and stress urinary incontinence. She was found to have stage II posterior vaginal wall prolapse. She desired definitive surgical management of her prolapse and opted for posterior vaginal repair. Although stress urinary incontinence was demonstrated on urodynamic testing, the decision was made not to proceed with concurrent midurethral sling given her history of pelvic floor dyssynergia and intermittent urinary retention. Here, Dr. Berkowitz and Dr. Hudson at MGH present and demonstrate a site-specific posterior colporrhaphy and perineorrhaphy.

PUBLISHED: Shouldice Repair for Left Direct Inguinal Hernia

Shouldice Repair for Left Direct Inguinal Hernia

Michael Reinhorn, MD, FACS
Mass General Brigham – Newton-Wellesley Hospital
Boston Hernia and Pilonidal Center
Tufts University School of Medicine

Divyansh Agarwal, MD
Massachusetts General Hospital

Lauren Ott, PA-C
Mass General Brigham – Newton-Wellesley Hospital
Boston Hernia and Pilonidal Center
Tufts University School of Medicine

In this article, Dr. Michael Reinhorn shows the case of a 51-year-old male who presented with left groin pain and a bulge in the area, worsened while straining or after a long day of physical activity. The patient underwent a mesh-free hernia repair performed via the four-layer Shouldice technique as a 50-minute ambulatory/day-surgery procedure. This article and the associated video describe the pertinent history, evaluation, and operative steps of the procedure.

PUBLISHED: Laparoscopic Suture Rectopexy with Culdoplasty, Vaginal Wall Repair, and Perineorrhaphy for Rectal Prolapse

Laparoscopic Suture Rectopexy with Culdoplasty, Vaginal Wall Repair, and Perineorrhaphy for Rectal Prolapse

Marcus V. Ortega, MD;Emily C. Von Bargen, DO; Liliana Bordeianou, MD

Massachusetts General Hospital

This is the case of an 87-year-old female who presented with a history of constipation and bothersome rectal prolapse that required manual rectal prolapse reduction. She had minimal constipation and minimal incontinence, and anorectal manometry revealed low rectal pressures. On exam, she was found to have full-thickness rectal prolapse and stage II posterior vaginal wall pelvic organ prolapse. Gynecological POP-Q exam showed mostly posterior prolapse and some apical prolapse, and urodynamic testing was negative. Defacography revealed an enterocele. Here, Dr. Bordeianou and Dr. Von Bargen at MGH discuss the decision-making process when treating rectal prolapse and perform a laparoscopic suture rectopexy with culdoplasty, vaginal wall repair, and perineorrhaphy with levator plication.