Enterocele repair by abdominal obliteration of the pelvic inlet: long-term outcome on obstructed defaecation and symptoms of pelvic discomfort.
OBJECTIVE
Enterocele is defined as a herniation of the peritoneal sac between the vagina and the rectum. This may contain either sigmoid colon or small bowel. It has been reported that enterocele is associated with obstructed defaecation and symptoms of pelvic discomfort. The aim of the present study was to evaluate the long-term effect of enterocele repair.


METHODS
In the time period between 1994 and 2003, 54 women (median age 54 years; range: 31-80) with a symptomatic enterocele underwent obliteration of the pelvic inlet with a U-shaped Mersilene mesh. All patients underwent evacuation proctography (EP), which was repeated 6 months after the repair. In addition, they were contacted over the telephone to assess the long-term effect of enterocele repair. Forty-nine patients were willing to answer questions over the telephone. Five patients were lost to follow-up (response rate: 91%).


RESULTS
Six months after the procedure, EP revealed a recurrent or persistent enterocele in five (9%) patients, which was symptomatic in two, both of whom underwent a second repair. Among the 49 patients without an enterocele after 6 months, 10 (23%) women encountered recurrent symptoms of pelvic discomfort at a median follow-up of 85 months (range: 3-137). Despite adequate correction of the enterocele, obstructed defaecation persisted in 21 (75%) patients of 28, who presented with this problem before the procedure. De novo dyspareunia occurred in 5% of the women after the procedure.


CONCLUSIONS
Obliteration of the pelvic inlet with a U-shaped Mersilene mesh provides an effective tool for anatomical correction of enteroceles. However, in the long term one of four patients encounters recurrent symptoms of pelvic discomfort. It seems unlikely that enterocele contributes to obstructed defaecation, as evacuation difficulties persist in around three quarters of the patients.
Oom
D M J
DM
Colorectal Research Group of the Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands.
van Dijl
V R M
VR
Gosselink
M P
MP
van Wijk
J J
JJ
Schouten
W R
WR
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003248:Constipation / Q000209:etiology; D005260:Female; D059685:Herniorrhaphy; D006801:Humans; D008875:Middle Aged; D010388:Pelvis / Q000601:surgery; D010537:Peritoneum / Q000601:surgery*; D011859:Radiography; D012002:Rectal Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D013526:Surgical Mesh; D013997:Time Factors; D016896:Treatment Outcome; D014623:Vaginal Diseases / Q000000981:diagnostic imaging / Q000601:surgery*