Vulvovaginal Surgery - Obstetrics and Gynecology

Vulvovaginal Surgery:
From Office to the Operating Room
Hope K. Haefner, MD
Loyola
March 2013
Learning Objectives
At the end of this presentation, the participant will:
•
•
Increase knowledge on the variety of
vulvovaginal procedures being performed in
office and in the operating room
View videos of a variety of surgical procedures
including skin grafts and flaps
Tips
Tips
Tips
Tips
•The solution to
pollution is dilution
Irrigation
Tips
Tips
Tips
Tip
Know the anatomy
Prepuce
Prepuce
Labium Majus
Labia Majora
Labia Minora
Labium Minus
Bartholin Ducts
Surgical Treatment of
Lichen Sclerosus
• Limited role (high rate of
recurrence)
• Surgical division of mucosal
adhesions helpful in clitoral
phimosis, introital narrowing
Tip- Do not do this on Lichen
Planus Patients
Bartholin Cysts
Various Treatments
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•
•
•
•
Fistulization (Word catheter placement)
Marsupialization
CO2 laser vaporization
Silver nitrate ablation
Gland? - Duct excision
Marsupialization
• Useful for treatment of both cysts and abscesses
• Vertical incision (just distal to hymenal ring) or
removal of ellipse of skin 2/3 the size of cyst
• Cyst wall sutured to vestibule
• Can be performed in office or OR
• Quick, minimal blood loss, fast recovery, minimal
scarring, preservation of gland function
• Systematic review of literature showed 0
recurrences in 70 patients followed for > 1
month
(Wechter et al. Obstetrical and Gynecologic Survey 2009; 64: 395-404.)
Excision
• Indicated for recurrent cysts refractory to other
techniques or for suspicion of adenocarcinoma
• Most serious complication – bleeding
• Loss of physiologic function as well as higher potential
for scarring and disfigurement
• MRI may be useful pre-operatively in defining extent of
disease
• 168 patients in systematic review of literature with at
least 2 years follow-up
-Recurrence ranged from 0-3%
-Bleeding or hematoma reported in 2-8%
(Wechter et al. Obstetrical and Gynecologic Survey 2009; 64: 395404.)
Botched Bartholin Cyst
Botched Bartholin Cyst
Marsupialization
Removal of Recurrent
Bartholin Cyst Video
Skene’s Duct Cyst Surgery
Video
Surgery
Surgery
Split Thickness Skin Grafts

One procedure
– Vulvar intraepithelial neoplasia
– Paget
– Cancers

Two procedures
– Hidradenitis suppurativa
Paget’s Disease
Split Thickness Skin Grafts
4 Months Post Op Grafts
2 Years After Surgery
Extensive Hidradenitis vs. Crohn’s
Recent Admission 2 Years Later
Video of Surgery for
Hidradenitis Suppurativa
Video
Full Thickness Skin Grafts
Full Thickness Skin Grafts
Full Thickness Skin Grafts
Video
• Several patient scenarios will be
presented and the audience will vote on
whether or not a labial reduction, or
other vulvar procedures should be
performed
Summary