Site-Specific Rectocele Repair Compared With Standard Posterior Colporrhaphy

ArticleinObstetrics and Gynecology 105(2):314-8 · March 2005with52 Reads
DOI: 10.1097/01.AOG.0000151990.08019.30 · Source: PubMed
Abstract
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. II-3.
    • "If needed, perineal body reconstruction can be performed. The success rate of site-specific repair ranges from 59% to 100% [36,37]. The de novo constipation rate is from 3% to 4% [38,39], and the de novo dyspareunia rate is from 0% to 8% [34,37383940. "
    [Show abstract] [Hide abstract] ABSTRACT: Quality of life is adversely affected by pelvic organ prolapse, the prevalence of which is increasing because of the persistently growing older population. Today, the tension-free vaginal mesh kit has grown in popularity owing to its comparable cure rate to traditional reconstructive surgery and the feasibility of an early return to normal life. However, significant debate remains over the long-term cure rate and the safety of tension-free vaginal mesh in the United States. The U.S. Food and Drug Administration recommends obtaining informed consent about the safety and cure rate when the patient chooses surgery using the tension-free vaginal mesh kit or meshes before surgery. The goal of surgery for pelvic organ prolapse is the restoration of anatomic defects. This review article provides an overview of basic surgical techniques and the results, advantages, and disadvantages of surgery for pelvic organ prolapse.
    Full-text · Article · Nov 2014
    • "Although we have no age-matched control group of women, we find this dyspareunia rate acceptable, especially when compared with studies reporting dyspareunia inFig. 2 Cumulative incidence of reoperation following native tissue repairs for pelvic organ prolapse (POP) 2002–2005 (n=699) up to 62 % of patients after posterior POP repairs using synthetic mesh [21]. Our dyspareunia rate of 8.9 % is also considerably lower than the postoperative dyspareunia rate of 16–17 % described by Abramov et al. after both classic posterior colporrhaphy and native tissue site-specific repairs [22]. We believe our relatively low dyspareunia rate is due to careful reconstruction of the perineal body and also to systematically avoiding levator ani muscle suturing in sexually active women. "
    [Show abstract] [Hide abstract] ABSTRACT: There are large variations in reported frequency of recurrence and subsequent treatment after pelvic organ prolapse (POP) surgery. We hypothesized that native tissue repair entails high subjective satisfaction and good objective results, with low POP reoperation rates and few complications. The 1-year results of 699 women having had native tissue repair for POP at our urogynecological unit from 2002 to 2005 were evaluated using an internal quality control database. A short-form physician check list for patient subjective and objective outcomes has been routinely used for 1-year controls since 2002, and results are registered longitudinally in the database. Patients' medical records up to 2012 were reviewed for information on recurrent POP symptoms. A telephone interview was performed to assess POP recurrences potentially treated elsewhere. The cumulative incidence for reoperation was calculated comparing partial with complete (surgical treatment of all three compartments) native tissue repairs. Subjective satisfaction was stated by 94 % of patients at the 1-year control, and 84 % had stage 0-I in any compartment using the POP Quantification (POP-Q) system. The 5-year reoperation rate was significantly lower in the complete vs. the partial (2.6 % vs. 8.9 %) repair group. Cumulative incidence of reoperation showed a slight but constant increase over the years. POP surgery using native tissue repair entails low reoperation rates with excellent subjective and objective results and should be the first choice in treating primary POP, providing use of adequate surgical technique.
    Full-text · Article · Jul 2013
    • "Petersen et al. [8] reported that the combination of STARR and laparoscopy provided the opportunity to perform a trananal rectal resection without the threat of intraabdominal organs caused by the enterocele. 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 rectovaginal212223. 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. "
    [Show abstract] [Hide abstract] 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.
    Full-text · Article · Jun 2012
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