Rectocele plication: description of a novel surgical technique and review of clinical results

Introduction and hypothesis A rectocele is the bulging of the anterior rectal wall into the posterior vaginal compartment. The route of surgical repair can be transvaginal, transrectal or abdominal. The aim of this retrospective study is to describe a novel transvaginal surgical procedure and invest...

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Bibliographic Details
Published in:	International Urogynecology Journal Vol. 29; no. 11; pp. 1655 - 1660
Main Authors:	Henn, Etienne W., Cronje, Hennie S.
Format:	Journal Article
Language:	English
Published:	London Springer London 01-11-2018 Springer Nature B.V
Subjects:	Aged Clinical outcomes Constipation - etiology Constipation - surgery Fecal Incontinence - etiology Fecal Incontinence - surgery Female Gynecology Humans Medicine Medicine & Public Health Middle Aged Original Article Quality of Life Rectocele - etiology Rectocele - surgery Rectum - surgery Retrospective Studies Surgical techniques Treatment Outcome Urology Uterine Prolapse - etiology Uterine Prolapse - surgery Prolapse surgery Posterior repair Rectocele plication rectocele repair Rectocele Quality of life
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Summary:	Introduction and hypothesis A rectocele is the bulging of the anterior rectal wall into the posterior vaginal compartment. The route of surgical repair can be transvaginal, transrectal or abdominal. The aim of this retrospective study is to describe a novel transvaginal surgical procedure and investigate the associated subjective and objective clinical outcomes. Methods Database records were retrieved for all women who underwent a rectocele plication for the period from January 2010 until December 2015 in a referral urogynecology unit with a minimum follow-up period of 12 months. This transvaginal technique entails a plication of the anterior rectal wall by suturing of the rectal muscularis layer. Clinical findings and quality of life (QOL) metrics were evaluated and reported on. Results One hundred thirty-nine women met the initial inclusion criteria with full data available for 123. The presenting symptoms included a vaginal bulge in 73 (52.5%), overactive bladder (OAB) in 73 (52.5%), obstructed defecation (OD) in 49 (35.3%) and anal incontinence (AI) in 35 (25.2%). The majority of women ( n = 72, 51.8%) had stage 3–4 posterior prolapse. The mean follow-up period was 27 ± 15 months. The postoperative symptoms were significantly improved for all, except AI ( p = 0.43). There was a significant improvement in posterior prolapse ( p < 0.001) with the majority of women noted to have a stage 0 or 1 ( n = 109; 88.6%) posterior prolapse at follow-up. Conclusions The rectocele plication is a novel surgical technique with good subjective and objective clinical outcomes in the medium term.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0937-3462 1433-3023
DOI:	10.1007/s00192-018-3623-5