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.


CONCLUSIONS
Complete rectovaginal septum reinforcement with mesh corrected complex rectoceles, with good functional outcome.
D'Hoore
A
A
Department of Abdominal Surgery, University Clinics Gasthuisberg, Leuven, Belgium. andre.dhoore@uz.kuleuven.ac.be
Vanbeckevoort
D
D
Penninckx
F
F
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004210:Dissection; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007443:Intussusception / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D010535:Laparoscopy; D008365:Manometry; D008875:Middle Aged; D011126:Polypropylenes / Q000627:therapeutic use; D011859:Radiography; D020047:Rectocele / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D013526:Surgical Mesh; D013536:Suture Techniques; D014621:Vagina / Q000601:surgery*
D011126:Polypropylenes