Midline rectovaginal fascial plication for repair of rectocele and obstructed defecation.
OBJECTIVE
To estimate the efficacy of midline fascial plication of the posterior vaginal wall in women with rectoceles and obstructed defecation.


METHODS
Prospective evaluation of 38 consecutive women with symptomatic rectoceles (stage II or greater) and obstructed defecation included pre- and postoperative standardized pelvic floor questions, pelvic organ prolapse quantification measurements, validated bowel function questionnaires, defecating proctogram, and patient satisfaction. Reviews were conducted by nonsurgical coauthors.


RESULTS
The median follow-up was 12.5 months (range 2.5-26 months). The subjective success rates were 97% (95% confidence interval [CI] 0.83-1.00%) at 12 months and 89% (95% CI 0.55-0.98%) at 24 months. The objective success rates were 87% (95% CI 0.64-0.96%) at 12 months and 79% (95% CI 0.51-0.92%) at 24 months. The average points, Ap and Bp, were significantly reduced from -0.1 (range -2 to 3) and 1.1 (range -1 to 8), preoperatively, to -2.6 (range -3 to -1) and -2.5 (range -3 to 0), postoperatively, respectively (P <.001). Depth of rectocele also reduced postoperatively on defecating fluoroscopy (P <.001). The correction of the anatomical defect was associated with improved functional outcome, with 33 women (87%) no longer experiencing obstructed defecation, and there was a significant reduction in postoperative straining to defecate, hard stools, and dyspareunia (P =.001). The improved anatomical and functional outcomes were reflected in the fact that 97% of the women reported very high patient satisfaction.


CONCLUSIONS
Midline fascial plication is effective in correcting anatomical and functional outcomes associated with symptomatic rectoceles and obstructed defecation.


METHODS
III
Urogynaecology Unit, Royal Women's and Mater Hospitals, 30 Chasely Street, Auchenflower 4066, Brisbane, Australia. chrismaher@urogynaecology.com.au
Christopher F
CF
Maher
Aymen M
AM
Qatawneh
Kaven
K
Baessler
Philip J
PJ
Schluter
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003248:Constipation / Q000473:pathology / Q000601:surgery*; D000071938:Fasciotomy; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods; D006801:Humans; D008875:Middle Aged; D017060:Patient Satisfaction; D011446:Prospective Studies; D020047:Rectocele / Q000473:pathology / Q000601:surgery*; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D014596:Uterine Prolapse / Q000473:pathology / Q000601:surgery*; D014621:Vagina / Q000601:surgery