Aram Bonni, M.D., offers state-of-the-art treatments for a wide range of pelvic floor disorders that affect patients. Everything from simple office procedures to minimally invasive out patient surgeries to more complicated and reconstructive surgeries are available and tailored to fit your need. Dr. Bonni is dedicated to help you return to your normal activities comfortably and confidently.
If you have any suggestions, questions or concerns or if you want to schedule an appointment after browsing the following topics in our pelvic surgery section, please contact Pelvic Pro. We have availabilities in Los Angeles, Orange County , and San Bernardino.
Adhesions are usually comprised of scar tissues caused by previous surgery or other diseases. According to the location and organs that they affect symptoms may vary. In women intestinal and pelvic adhesions are not that uncommon and often times are the cause of abdominal and pelvic pain, gastrointestinal symptoms, painful intercourse ( dyspareunia) , voiding complaints and infertility. Adhesiolysis is the surgical removal or separation of adhesions. The use of minimally invasive laparoscopic techniques and adhesion barriers during adhesiolysis can minimize blood loss and complications. Laparoscopic enterolysis is a minimally invasive procedure that unblocks the small bowel by excising the adhesions.
This usually refers to repair of the area between the vagina and the rectum. Childbirth, weight gain , aging, trauma and prior surgery can cause the perineal muscles of the vagina to weaken or tear. Because these muscles are responsible for keeping the opening of the vagina narrow, patients with damaged perineal muscles often are troubled by the loss of function and weakened anatomy. The repair of the perineal muscles and perineal body would restore normal anatomy and function is also known as perineoplasty. it is frequently performed in conjunction with vaginal rejuvenation and pelvic prolapse surgery.
Sling Revision / Removal
Slings are usually performed to attend to urinary incontinence. There are many different types of slings but nowadays most commonly used Slings are synthetic tension free type tapes that are placed underneath the urethra. In some patients these slings could cause problems such as retention, incomplete emptying and other dysfunctional voiding symptoms. In some circumstances they would need to be removed and in some other situations they could be preserved but revised. These procedures are often time difficult and complicated secondary to extensive scarring and delicate surrounding tissues specially the urethra ( the tube that connects bladder to outside). Suburethral slings remain highly successful and sought after procedures for urinary incontinence. Insertion of these kinds of tapes in expert hands is safe. Placement of these kinds of meshes is different than those in FDA warning. Sling revisions and removals should be done by experts who are familiar with and have performed many of these procedures.
Vaginal Mesh Complications
For many years repair of the prolapsing pelvic organ would be carried out using the native tissues. There has been a surge in usage of vaginal meshes in the past ten years. The main advantage of these graft augmented repairs seems to be decreased chance of recurrence of the prolapse. These procedures unlike the push in the market are not simple operations that could be done on all prolapse cases by inexperienced surgeons. Unfortunately this has resulted in an increased number of mesh related complications. These include but are not limited to bleeding, infection, injury to bladder and surrounding viscus organs, pelvic pain, buttock, painful intercourse, buttock and leg pain, dysfunctional urinary symptoms and graft erosion to vagina or other surrounding organs. Repair and removal of these meshes and correction of their complications are difficult surgeries that need expertise in female pelvic medicine and reconstructive pelvic surgery. Dr. Bonni is fellowship trained in this area and has the skills and surgical experience necessary to treat mesh complications and restore the normal function and anatomy to the pelvic floor.
Vesicovaginal Fistula Repair
A vesicovaginal fistula is an abnormal connection between the bladder and the vagina. This type of fistula is usually caused by complications of child birth in developing countries. In US they are mostly secondary to trauma, injury or complication of pelvic surgery in women. They may cause pain, bloody vaginal discharge, and urinary incontinence. Many different types of repair is available. If possible Dr. Bonni repairs these using a vaginal approach and if not then laparoscopic or open routes are chosen on a case by case basis. The fistula and the connection is identified and meticulously separated from the surrounding viable organs and tissues. It is then resected and the openings are closed in layers.