A Gynecologic Report

It has been a good week, a good patient mix and a good number of total patients. Dr. Sierra did an excellent job of scouring the country for the group of patients.
We arrived on Saturday and drove all the way to Clinica Ezell on that day. That allowed for unpacking of supplies and orientation as well as planning for the next day's activities.
After a wonderful Sunday worship service, we evaluated that afternoon's patients. During the course of the afternoon we would evaluate the next day's patients, making sure that they were candidates for what we had to offer. This allowed an earlier start for O.R. time as opposed to seeing the patients on the day of their planned surgery. This was a pattern that was repeated each day to facilitate each operating day.
An example of a patient beyond our scope was a 44 year old woman with a large pelvic mass, ascites and an ultrasound report suggestive of ovarian cancer. Her needs were unfortunately beyond our capabilities. Dr. Lisa Dunham compassionately and expertly helped her, calling on the Great Physician to heal her and made arrangements for gyn oncologic care in the city.
A common problem seen on this trip was complete vaginal vault prolapse with massive eversion. A procedure that gave a very good post-operative result, at least in the immediate post op period was total vaginal hysterectomy, bilateral uterosacral suspension (high), and posterior repair with a levator plication. The foley was left in for two days and then removed. Very few patients had difficulty with voiding after that. I think that a good comparison study is needed to determine which procedures yield the best long term results with the greatest degree of safety.
Roy Kellum