Vaginal repair of rectocele after dynamic graciloplasty for fecal incontinence due to imperforate anus.
A 35-years-old woman developed obstructed defecation due to a large (6 cm) non-emptying rectocele one year after successful electrostimulated gracilis neosphincter operation for correction of fecal incontinence after surgery for imperforate anus. Surgical correction of the rectocele was performed by a trans-vaginal approach due to the poor elasticity of the neoanus and avoidance of possible damage to the neosphincter. After physiological investigations, including defecography, the patient had a resection of the posterior vaginal mucosal wall, a double layer plication of the muscular wall with non-absorbable suture and a longitudinal mucosal suture. The postoperative course was uneventful. Defecography, performed 3 and 6 months later, showed a marked reduction of the rectocele (2 cm) which corresponded to clinical improvement. Occurrence of disabling rectocele can be considered a possible long term complication after successful electrostimulated neosphincter procedure in patients at risk for developing a rectocele; a successful repair can be obtained using trans-vaginal approach without the risk of neosphincter damage. Transvaginal repair of rectocele in similar clinical situations may be recommended.
Altomare
D F
DF
Istituto di Clinica Chirurgica, University of Bari, Italy.
Rinaldi
M
M
Pannarale
O
O
Martinelli
E
E
Palasciano
N
N
Memeo
V
V
D000328:Adult; D001003:Anal Canal / Q000601:surgery*; D001006:Anus, Imperforate / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D003672:Defecation; D004599:Electric Stimulation Therapy; D005242:Fecal Incontinence / Q000150:complications / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008722:Methods; D018482:Muscle, Skeletal / Q000637:transplantation*; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D012005:Rectal Prolapse / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D014621:Vagina / Q000601:surgery*