[Transvaginal mesh perineal repair of the rectovaginal septum in the treatment of rectocele and enterocele. Outcomes in 77 patients].
OBJECTIVE
Anatomical and functional outcomes after transvaginal perineoplasty of the vaginal septum using polypropylene mesh in 77 patients with rectocele, enterocele, or both were studied. The frequency of other associated pelvic floor defects was also analyzed.


METHODS
Between 1997 and May 2005, 77 patients underwent surgery (30 for enterocele, 33 for rectocele and 14 for both defects). In all patients, complete dissection of the rectovaginal space, resection of the redundant vaginal wall tissue, suturing of the polypropylene mesh to the lateral bundles of the puborectal muscle, and posterior colporrhaphy were performed. In enteroceles, Douglas' pouch was resected before the mesh was placed.


RESULTS
During follow-up, there were 3 minimal vaginal dehiscences requiring partial extirpation of the mesh in 2 (12.1%), and 1 (1.2%) rectocele recurrence. No subsequent mesh extrusions or recurrences were detected during follow-up. The frequency of associated pelvic floor disorders was 92%.


CONCLUSIONS
In our experience, placement of polypropylene mesh in the rectovaginal septum with lateral suturing to puborectal muscle bundles provides excellent results compared with other approaches and meshes that are not sutured and fixed in the rectovaginal space, leading to mesh infection, extrusion or complete removal.
Servicio de Cirugía, Hospital Príncipe de Asturias, Alcalá de Henares, Madrid, Spain. jescribano.g@hotmail.com
Jorge
J
Escribano-Guijarro
Mercedes
M
Jáñez-Furió
Emilio
E
Sánchez-Colodrón
Javier
J
Angulo-Cuesta
Franciaco Javier
FJ
González-García
José Luis
JL
Cárdenas-Olivas
D000368:Aged; D000369:Aged, 80 and over; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods; D005260:Female; D059685:Herniorrhaphy; D006801:Humans; D007410:Intestinal Diseases / Q000601:surgery; D008875:Middle Aged; D010502:Perineum / Q000601:surgery*; D011126:Polypropylenes; D020047:Rectocele / Q000601:surgery*; D013526:Surgical Mesh; D016896:Treatment Outcome; D014621:Vagina
D011126:Polypropylenes