Site-Specific Rectocele Repair Compared With Standard Posterior Colporrhaphy
Evanston Continence Center, Evanston Northwestern Healthcare, Northwestern University, Feinberg School of Medicine, 1000 Central Street, Evanston, IL 60201, USA. Obstetrics and Gynecology
(Impact Factor: 5.18).
03/2005; 105(2):314-8. DOI: 10.1097/01.AOG.0000151990.08019.30
To compare the anatomic and functional outcomes of site-specific rectocele repair and standard posterior colporrhaphy.
We reviewed charts of all patients who underwent repair of advanced posterior vaginal prolapse in our institution between July 1998 and June 2002 with at least 1 year of follow-up.
This study comprised 124 consecutive patients following site-specific rectocele repair and 183 consecutive patients following standard posterior colporrhaphy without levator ani plication. Baseline characteristics, including age, body mass index, parity, previous pelvic surgeries, and preoperative prolapse were not significantly different between the 2 study groups. Recurrence of rectocele beyond the midvaginal plane (33% versus 14%, P = .001) and beyond the hymenal ring (11% versus 4%, P = .02), recurrence of a symptomatic bulge (11% versus 4%, P = .02), and postoperative Bp point (-2.2 versus -2.7 cm, P = .001) were significantly higher after the site-specific rectocele repair. Rates of postoperative dyspareunia (16% versus 17%), constipation (37% versus 34%), and fecal incontinence (19% versus 18%) were not significantly different between the 2 study groups.
Site-specific rectocele repair is associated with higher anatomic recurrence rates and similar rates of dyspareunia and bowel symptoms than standard posterior colporrhaphy.
Available from: PubMed Central
- "Transvaginal repair consists of the plication of the levator muscle or the plication of the rectovaginal fascia to strengthen the rectovaginal septum or to close the specific defect of the rectovaginal fascia [21-23]. The tranvaginal approach is less likely to have an influence on the anal sphincter parameters (without compromising sphincter function) and allows the enterocele to be treated simultaneously. "
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ABSTRACT: This study was aimed to compare the results of a transanal repair with those of a transvaginal levatorplasty and to determine the long-term clinical outcomes according to the change in the depth of the rectocele after the procedure.
Of 50 women who underwent a rectocele repair from March 2005 to February 2007, 26 women (group A) received a transanal repair, and 24 (group B) received a transvaginal repair with or without levatorplasty. At 12 months after the procedures, 45 (group A/B, 22/23 women) among the 50 women completed physiologic studies, including anal manometry and defecography, and clinical-outcome measurements. The variations of the clinical outcomes with changes in the depth of the rectocele were also evaluated in 42 women (group A/B, 20/22) at the median follow-up of 50 months.
On the defecographic findings, the postoperative depth of the rectocele decreased significantly in both groups (group A vs. B, 1.91 ± 0.20 vs. 2.25 ± 0.46, P = 0.040). At 12 months after surgery, 17 women in each group (group A/B, 77/75%) reported improvement of their symptoms. However, only 11 and 13 women (group A/B, 55/59%) of groups A and B, respectively, maintained their improvement at the median follow-up of 50 months. Better results were reported in patients with a greater change in the depth of their rectocele (≥4 cm) after the procedure (P = 0.001)
In both procedures, clinical outcomes might become progressively worse as the length of the follow-up is increased.
Available from: urofrance.org
- "Myorraphie haute 36 ? 14 Gêne sexuelle chez 3 patientes Weber et al. (2000)  Colporraphie postérieure ± autres gestes 53 53 53 26 % de dyspareunie postopératoire (significativement plus élévé qu'en l'absence de colporraphie postérieure) Abramov et al. (2005)  Réparation postérieure « site spécifique » "
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ABSTRACT: Sexual well-being is an important parameter of women's health and quality of live. Sexual disorders may occur in women with pelvic organ prolapse and/or stress urinary incontinence and also after pelvic reconstructive surgery. Sexual dysfunction after POP or SUI surgery has been poorly documented but new condition specific questionnaires have been developed to help us to better evaluate such consequences. This paper reports updated data and highlights more specifically consequences of surgery with mesh reinforcement which is, currently, an important issue particularly when performing by vaginal approach.
Available from: Myung Jae Jeon
- "Discrete site-specific repair, based on the concept of Richardson et al. is also reported to be suboptimal. In a retrospective case-control study, Abramov et al., noted a significantly higher anatomical recurrence rate of rectoceles and similar rates of dyspareunia and bowel symptoms following site-specific repair compared to traditional midline plication.46 "
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ABSTRACT: There has been growing interest in the use of grafts in pelvic reconstructive surgery. This article will address available graft materials and assess their clinical efficacy and safety. We conducted a Pubmed MEDLINE literature search for full-length English text studies with follow-up periods of at least one year. There are many reports on synthetic and biological graft materials; the majority are not well-designed, have short-term follow-up, small sample sizes, and poor outcome assessment. The use of non-absorbable synthetic grafts may offer excellent anatomical cure rates. However, it is associated with a high incidence of graft-related complications, including healing abnormalities and adverse bladder, bowel, and sexual function effects. These complications can be decreased with absorbable synthetic meshes, but efficacy is lower compared to non-absorbable ones. There is insufficient evidence in favor of biological grafts. In conclusion, based on current knowledge, routine application of grafts in pelvic reconstruction is not recommended. It is preferred that graft utilization be individualized, with close monitoring for complications.
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