Clinical, physiological and radiological assessment of rectovaginal septum reinforcement with mesh for complex rectocele.

BACKGROUND: Rectocele can be part of a more complex rectal prolapse syndrome including rectal intussusception and enterocele. This reflects insufficiency at different levels of support in the posterior pelvic compartment. A new technique involving reinforcement of the rectovaginal septum with mesh by a combined laparoscopic and perineal approach was evaluated. METHODS: The study included 18 patients with a complex rectocele and grade 2-3 rectal intussusception and enterocele (eight patients). Patients had clinical, physiological and radiological follow-up. RESULTS: There was no major perioperative morbidity and mean hospital stay was 4.5 (range 3-7) days. After a mean of 24.2 (range 13-35) months there was no clinical recurrence of rectocele. Symptoms of obstructed defaecation resolved in 14 of 17 patients. The Patient Assessment of Constipation Symptoms score decreased from a mean(s.d.) of 12.6(5.9) to 3.9(4.2), and a rectocele symptom score from 14.3(3.3) to 2.3(2.8). No new-onset constipation, urge or faecal incontinence nor new-onset dyspareunia was reported. Radiological investigation in eight patients revealed a sufficient anatomical repair at the different levels of support. A slight decrease in rectal compliance was measured, with no significant reduction in rectal capacity. CONCLUSION: Complete rectovaginal septum reinforcement with mesh corrected complex rectoceles, with good functional outcome.

Functional and anatomic outcome after transvaginal rectocele repair using collagen mesh: a prospective study.

PURPOSE: This study was designed to evaluate rectocele repair using collagen mesh. METHODS: 32 female patients underwent surgical repair using collagen mesh. Outcome was assessed in 29 patients and preoperative assessment included standardized questionnaire, clinical examination, and defecography. At the six-month follow-up, patients answered a standardized questionnaire and underwent clinical examination. At the 12-month follow-up, patients answered a standardized questionnaire, underwent clinical examination, and defecography. RESULTS: Preoperatively, 26 patients had a Stage II and 3 patients had a Stage III rectocele. At the 6-month follow-up, five patients had rectocele > or = Stage II (P < 0.001) and at the 12-month follow-up, seven patients had rectocele > or = Stage II (P < 0.001) at clinical examination. At the preoperative defecography, all patients presented a rectocele. At the 12-month defecography, 14 patients had no rectocele (P < 0.001) and 15 had a rectocele. At the six-month follow-up, there was a significant decrease in rectal emptying difficulties, need of digital support of the posterior vaginal wall at defecation, and defecation frequency. At the 12-month follow-up, symptom improvement remained, but was less pronounced. CONCLUSIONS: Rectocele repair using collagen mesh improved anatomic support, but there is a substantial risk for recurrence with unsatisfactory anatomic and functional outcome one year after surgery. Rectocele repair using mesh was not associated with an increased risk of dyspareunia. Rectocele repair using biomaterial mesh reinforcement needs further evaluation before adopted into clinical practice.

Defeitos do compartimento vaginal posterior: fisiopatologia e tratamento da retocele / Defects of vaginal posterior compartment: pathophysiology and treatment of rectocele

A retocele é definida como uma herniação da parede anterior do reto e posterior da vagina em direção ao lúmen vaginal. A etiologia da retocele é variada, e como tal, o tratamento deve ser sítio específico. Apenas a miorrafia dos elevadores pode não resolver o problema e comprometer a evacuação, bem como dificultar o acesso ao sítio específico do defeito em futuras intervenções cirúrgicas. O uso de telas sintéticas, especialmente as de polipropileno, se mostra como um recurso valioso nas mulheres que apresentam o septo retovaginal muito atrófico ou com lesão extensa, que impossibilita sua reconstituição.