Category Archives: Ob/Gyn

General Surgery, Global Surgery, Ob/Gyn, Print Release

PUBLISHED: Abdominal Hysterectomy as a Surgical Approach in Large Fibroids

Abdominal Hysterectomy as a Surgical Approach in Large Fibroids
Jasmine Phun1; Col. Arthur C. Wittich, DO2
1Sidney Kimmel Medical College, Thomas Jefferson University
2Fort Belvoir Community Hospital (Retired)

Uterine fibroids, also known as leiomyomas, are usually benign masses that are most commonly found in women of reproductive age. Fibroids are usually asymptomatic and tend to be incidental findings on ultrasound. When clinically relevant, however, patients report symptoms such as menorrhagia, pelvic pain, and bulk-related symptoms.

Treatment of symptomatic fibroids may be pharmaceutical with gonadotropin-releasing hormone agonists, radiological using MRI-guided focused ultrasound surgery (or magnetic resonance-guided focused ultrasound), or minimally-invasive uterine artery embolization, but the treatment is largely surgical.

There are many different surgical approaches that can be utilized, including myomectomy or hysterectomy. Treatment of choice depends on multiple factors, including the severity of symptoms, size of fibroids, and patient’s desire to preserve fertility. However, out of all of the different surgical techniques available, hysterectomy is the only definitive treatment for these patients. Here, an abdominal hysterectomy was performed on a 45-year-old patient with symptomatic uterine fibroids.

General Surgery, Ob/Gyn, Print Release

PUBLISHED: Primary Low Transverse C-Section

Primary Low Transverse C-Section
Taylor P. Stewart, MD; Juliana B. Taney, MD
Massachusetts General Hospital

Cesarean sections, often referred to as c-sections, are the most common operation performed for pregnant people across the US. They are viewed as a safe mode of fetal delivery. While there are many indications for planned, non-elective primary cesarean deliveries, there are growing numbers of planned, elective primary c-sections in the US. Vaginal delivery should still be considered in all cases in which an elective c-section is requested. The decision regarding mode of delivery often involves an interdisciplinary discussion between obstetrical, anesthesia, and specialty teams as well as joint decision making between a patient and their provider, taking into consideration their concerns and long-term goals.

In this case, an elective primary c-section was performed on a 31-year-old gravida 1 para 0 patient with a term, singleton gestation in the setting of prior lumbar sacral fusion and pelvic fixation surgeries.

General Surgery, Ob/Gyn, Print Release

PUBLISHED: Vaginal Hysterectomy, Uterosacral Ligament Suspension, Anterior Repair, and Perineorrhaphy

Vaginal Hysterectomy, Uterosacral Ligament Suspension, Anterior Repair, and Perineorrhaphy
Emily C. Von Bargen, DO; Patricia L. Hudson, MD; Lori R. Berkowitz, MD
Massachusetts General Hospital

This is the case of a 74-year-old female who presented with bothersome stage III pelvic organ prolapse. She desired definitive surgical management for her prolapse and opted for total vaginal hysterectomy, uterosacral ligament suspension, and anterior/posterior vaginal repairs. She had urodynamic testing before the surgery that showed no stress urinary incontinence, no detrusor overactivity, and normal bladder capacity. The surgery was uncomplicated. She was discharged home the same day as surgery, and her postoperative recovery was unremarkable.

General Surgery, Ob/Gyn, Print Release, Uncategorized

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.

General Surgery, Ob/Gyn, Print Release, Uncategorized

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.

General Surgery, Global Surgery, Ob/Gyn, Preprint Release

PREPRINT RELEASE: Abdominal Hysterectomy for Uterine Fibroids

Abdominal Hysterectomy for Uterine Fibroids
Hospital Leonardo Martinez, Honduras

Col. Arthur C. Wittich, DO
Fort Belvoir Community Hospital (Retired)
World Surgical Foundation

In this case, Dr. Wittich performs an abdominal hysterectomy on a 45-year-old female with symptomatic uterine fibroids. This was performed during a surgical mission in Honduras with the World Surgical Foundation.

Ob/Gyn, Preprint Release

PREPRINT RELEASE: Site-Specific Posterior Colporrhaphy and Perineorrhaphy for Rectocele


Site-Specific Posterior Colporrhaphy and Perineorrhaphy for Rectocele
Massachusetts General Hospital

Lori R. Berkowitz, MD
Assistant Professor of Obstetrics, Gynecology, and Reproductive Biology
Harvard Medical School

Patricia L. Hudson, MD
Female Pelvic Medicine and Reconstructive Surgery Fellow
Harvard Medical School

In this case, Dr. Berkowitz and Dr. Hudson perform a site-specific posterior colporrhaphy at MGH. The patient is a 38-year-old female who presented with fecal incontinence, constipation, and stress urinary incontinence, and was found to have stage II posterior vaginal wall prolapse. She desired definitive surgical management of her prolapse and opted for posterior vaginal repair.

General Surgery, Global Surgery, Ob/Gyn, Preprint Release

PREPRINT RELEASE: Vaginal Hysterectomy, Uterosacral Ligament Suspension, and Excision of Redundant Vaginal Tissue


Vaginal Hysterectomy, Uterosacral Ligament Suspension, and Excision of Redundant Vaginal Tissue
Romblon Provincial Hospital

Col. Arthur C. Wittich, DO
Fort Belvoir Community Hospital (Retired)
World Surgical Foundation

In this case, Dr. Wittich performs a vaginal hysterectomy, a high uterosacral ligament suspension, a round ligament suspension to the distal vaginal cuff, and a reduction of anterior and posterior redundant vaginal tissue. This was performed during a mission to the Philippines with the World Surgical Foundation.

Announcement, General Surgery, Ob/Gyn, Preprint Release

PREPRINT RELEASE: Laparoscopic Suture Rectopexy with Culdoplasty, Vaginal Wall Repair, and Perineorrhaphy


Laparoscopic Suture Rectopexy with Culdoplasty, Vaginal Wall Repair, and Perineorrhaphy
Massachusetts General Hospital

Liliana G. Bordeianou, MD
Associate Professor of Surgery
Harvard Medical School

Emily C. Von Bargen, DO
Female Pelvic Medicine and Reconstructive Surgery Associate Fellowship Director
Harvard Medical School

The patient in this case is an 87-year-old female with rectal prolapse. She had minimal constipation and minimal incontinence, and anorectal manometry revealed low rectal pressures. Gynecological POP-Q exam showed mostly posterior prolapse and some apical prolapse, and urodynamic testing was negative. Defecography revealed an enterocele. Here, Dr. Bordeianou and Dr. Von Bargen 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.

Announcement, General Surgery, Ob/Gyn, Preprint Release

PREPRINT RELEASE: Vaginal Hysterectomy, Uterosacral Ligament Suspension, Anterior Repair, and Perineorrhaphy


Vaginal Hysterectomy, Uterosacral Ligament Suspension, Anterior Repair, and Perineorrhaphy
Massachusetts General Hospital

Emily C. Von Bargen, DO
Female Pelvic Medicine and Reconstructive Surgery Associate Fellowship Director
Harvard Medical School

Patricia L. Hudson, MD
Female Pelvic Medicine and Reconstructive Surgery Fellow
Harvard Medical School

Lori R. Berkowitz, MD
Assistant Professor of Obstetrics, Gynecology, and Reproductive Biology
Harvard Medical School

This is the case of a 75-year-old multiparous female with stage 3 uterovaginal prolapse. Here, Dr. Emily Von Bargen performs a vaginal hysterectomy, uterosacral ligament suspension, anterior repair, and perineorrhaphy in order to alleviate this patient’s symptoms.