Journal of Minimally Invasive Surgery

The Korean Society of Endoscopic & Laparoscopic Surgeons (대한내시경복강경외과학회)
권호 표지
DOI QR코드

DOI QR Code

Laparoscopic Rectovaginal Septal Repair without Mesh for Anterior Rectocele

  • Kwak, Han Deok (Department of Surgery, Chonnam National University Hospital) ;
  • Ju, Jae Kyun (Department of Surgery, Chonnam National University Hospital)
  • Received : 2018.02.26
  • Accepted : 2018.05.16
  • Published : 2018.12.15
⟨ Previous Next ⟩

Abstract

A rectocele with a weakened rectovaginal septum can be repaired with various surgical techniques. We performed laparoscopic posterior vaginal wall repair and rectovaginal septal reinforcement without mesh using a modified transperineal approach. A 63-year-old woman with outlet dysfunction constipation complained of lower pelvic pressure and sense of heaviness for 30 years. Initial defecography showed an anterior rectocele with a 45-mm anterior bulge and perineal descent. Laparoscopic procedures included peritoneal and rectovaginal septal dissection directed toward the perineal body, rectovaginal septal suturing, and peritoneal closure. The patient started a soft diet the following day and was discharged on the 5th postoperative day without any complications. The patient had no dyschezia or dyspareunia, and no problem with bowel function; 3-month follow-up defecography showed a decrease in bulging to 18 mm. Laparoscopic posterior vaginal wall and rectovaginal septal repair is safe and feasible for treatment of a rectocele, and enables early recovery.

Keywords

References

  1. Nichols DH, Milley PS. Surgical significance of the rectovaginal septum. Am J Obstet Gynecol 1970;108:215-220. https://doi.org/10.1016/0002-9378(70)90299-1
  2. Mustain WC. Functional Disorders: Rectocele. Clin Colon Rectal Surg 2017;30:63-75.
  3. DeLancey JO. Structural anatomy of the posterior pelvic compartment as it relates to rectocele. Am J Obstet Gynecol 1999;1801:85-823.
  4. Acar HI, Kuzu MA. Important points for protection of the autonomic nerves during total mesorectal excision. Dis Colon Rectum 2012;55:907-912. https://doi.org/10.1097/DCR.0b013e318259b44f
  5. Nieminen K, Hiltunen KM, Laitinen J, Oksala J, Heinonen PK. Transanal or vaginal approach to rectocele repair: a prospective, randomized pilot study. Dis Colon Rectum 2004;47:1636-1642. https://doi.org/10.1007/s10350-004-0656-2
  6. Maher C, Baessler K, Glazener CM, Adams EJ, Hagen S. Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev 2007:Cd004014.
  7. Farid M, Madbouly KM, Hussein A, Mahdy T, Moneim HA, Omar W. Randomized controlled trial between perineal and anal repairs of rectocele in obstructed defecation. World J Surg 2010;34:822-829. https://doi.org/10.1007/s00268-010-0390-y
  8. D'Hoore A, Vanbeckevoort D, Penninckx F. Clinical, physiologica l and radiological assessment of rectovaginal septum reinforcement with mesh for complex rectocele. Br J Surg 2008;95:1264-1272. https://doi.org/10.1002/bjs.6322
  9. Paraiso MF, Barber MD, Muir TW, Walters MD. Rectocele repair: a randomized trial of three surgical techniques including gra fatugmentation. Am J Obstet Gynecol 2006;195:1762-1771. https://doi.org/10.1016/j.ajog.2006.07.026
  10. Maher C, Feiner B, Baessler K, Christmann-Schmid C, Haya N, Brown J. Surgery for women with anterior compartment prolapse. Cochrane Database Syst Rev 2016;11:Cd004014.