title: Perineal body repair in patients with third degree rectocele: a critical analysis of the tissue fixation system.
abstract: OBJECTIVE
  We describe the technique of tissue fixation system (TFS) perineal body repair in patients presenting with symptomatic third degree rectocele.
  
  
  METHODS
  The single sling TFS perineal body repair is performed in three surgical steps: (i) dissection of the rectum off the vagina and laterally displaced perineal body; (ii) identification of the deep transverse perineii muscles beyond their insertion point behind the descending pubic ramus; (iii) elevation and approximation of the separated and laterally displaced perineal bodies by insertion, without tension, of non-stretch 7 mm polypropylene tape into the bodies of the deep transverse perineii muscles.
  
  
  RESULTS
  From January 2007 to December 2009 we performed the TFS operation for 30 women, median age 61 (range 47-87) years, mean parity 2.6 (range 1-5), with third degree symptomatic low rectocele (median obstructive defaecation syndrome score 19; range 11-24). Median hospital stay was 24 (range 12-96) h. The median visual analogue scale for postoperative pain was 1 (range 1-7). Complications occurred in three cases (10%) and included a surfaced tape that was partly resected (repair maintained), a recurrence of the rectocele due to incorrect placement (failed repair) and a foreign body abscess requiring tape removal. At 12-month follow-up, 27 patients (90%) reported normal defaecation and the median obstructive defaecation syndrome score was significantly reduced to 4 (range 1-6; P < 0.001).
  
  
  CONCLUSIONS
  The TFS perineal body repair is an effective, safe, minimally invasive treatment in women with symptomatic low rectocele.
authors.affiliation: Clinic of Urology, Pediatric Urology and Andrology, Justus-Liebig-University, Giessen, Germany.
authors.forename: F M E
authors.initials: FM
authors.lastname: Wagenlehner
authors.forename: E
authors.initials: E
authors.lastname: Del Amo
authors.forename: G A
authors.initials: GA
authors.lastname: Santoro
authors.forename: P
authors.initials: P
authors.lastname: Petros
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D017773:Pelvic Floor / Q000601:surgery*; D010502:Perineum / Q000601:surgery*; D020047:Rectocele / Q000601:surgery*; D012189:Retrospective Studies; D053832:Surgical Tape; D016896:Treatment Outcome
keywords: Obstructed defaecation; perineal body; rectocele; tissue fixation system