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The pelvic floor supports the pelvic viscera and plays a role in normal urinary, gastrointestinal and reproductive function including parturition. Weakness of the pelvic floor can result in prolapse of the pelvic viscera and symptoms related to the anatomical and physiological changes. To date, prolapse and its treatment have focussed on restoration of the anatomy although symptom resolution may be more important to the patient. The symptoms attributable to prolapse have not been well defined, which makes the evaluation of treatments impossible. Neither have the factors that may influence symptoms and anatomical signs of pelvic organ prolapse been explored.

The subject matter for this research work is the area of perioperative recovery for patients undergoing major abdominal surgery. During clinical studies we have investigated some of the factors influencing postoperative recovery as well as suggesting strategies to improve patient care. The main focus of the scientific work of this thesis is the role of intravenous fluids in the perioperative management of patients undergoing abdominal surgery. We found that restriction of intravenous fluid in the postoperative period does not significantly improve recovery in terms of gastrointestinal function (4.2 (3.2-6.9) versus 4.7 (3.7-6.1) days; p=0.80) or hospital stay (5.9 (4.0-7.9) versus 5.8 (4.1-7.3) days; p=0.90). Analysing our findings in the context of what is already known suggests that the immediate perioperative period when the effect of the metabolic-endocrine response is at its greatest is the most important period for fluid management. During this period fluid optimisation has an important role in patient recovery but following this period the body’s own homeostatic mechanisms are more able to cope with any fluid excess. We also found that using a ‘fast-track’ regime we could reduce hospital stay to levels comparable with other studies in the published literature. Our work using a multi-modal rehabilitation regime in association with both laparoscopic and open surgery suggests that it is the postoperative care package which has the more major influence on recovery. Our findings are in agreement with other small sized studies beginning to appear in the literature and indicate that further large scale studies are required to determine the role of laparoscopic surgery and any potential benefits. One of the most significant causes of morbidity for patients undergoing abdominal surgery is postoperative ileus. During the course of our studies we found that the extent of surgery and particularly handling and exposure of the intestines seems to have little effect on the duration of postoperative ileus. These findings add to the previously contradictory findings of other groups. Our experience with ‘fast-track’ postoperative programmes was also applied to liver surgery, an area where it has not previously been reported, to show that a variety of abdominal procedures may benefit from this approach. By comparing our results with series published in the medical literature we found that hospital stay can be significantly reduced (4 versus 5-8 days).

This thesis sheds light on chronic pelvic pain in following areas: 1. Summarising prevalence of chronic pelvic pain 2. Exploring the risk factors in chronic pelvic pain, 3. Exploring beliefs on laparoscopic uterosacral nerve ablation and 4. Developing a protocol for a Multicentre randomised controlled trial of laparoscopic uterosacral nerve ablation.