Surgical Treatment of Rectocele as the Most Common Cause of Rectal Voiding Disturbances. Own Experience with the Use of Prosthetic Material
The aim of the study was to present different methods of reconstruction in case of rectovaginal septum defects, considering female patients with impaired colorectal voiding.Material and methods. During the period between 2001 and 2010, 39 female patients, aged between 42 and 75 years (mean age-58 years) were subject to surgical intervention. Patients complained of voiding disturbances, sensation of a "mass" in the pelvis (64.1%), dyspareunia (30.8%), anal sphincter insufficiency (17.9%) and urinary incontinence (10.3%).Defecography and MRI examinations confirmed rectocele (100%), enterocele (46.6%), pelvic floor prolapse (35.9%), vaginal prolapse (30.8%), and rectal prolapse (25.6%).Considering the surgical treatment of rectocele the following prosthetic material was used: polypropylene mesh and collagen implants (Pelvicol ®). In case of 19 patients with low rectocele the transvaginal approach was used. In case of high rectocele and coexisting pelvic organ prolapse the mesh was implanted by means of laparotomy (12 pts) or the abdomino-vaginal approach (8 pts).Results. Permanent reconstruction of the rectovaginal septum and withdrawal of voiding disturbances was observed in all patients operated by means of the transvaginal approach. Dyschesia symptoms were present in 16.6% of patients after mesh implantation by means of laparotomy, and in 12.5% of patients after the abdomino-vaginal approach. 10.3% of patients complained of pelvic pain and rectal tenesmus. All the above-mentioned symptoms were observed after polypropylene mesh implantation. The percentage of reoperations, due to complications amounted to 17.9%. Insignificant erosion of the prosthetic material was diagnosed in 7.7% of patients. 94.6% of patients were satisfied with the proposed treatment.Conclusions. The use of prosthetic material in the treatment of pelvic floor anatomical defects is an effective and safe method, considering patients with colorectal voiding disturbances.
- Lechaux JP, Lechaux D, Bataille P et al.: Transperineal repair of rectocele with prosthetic mesh. A propective study. Ann de Chirurgie 2004; 129: 211-17.
- Nieminen K, Hiltunen KM, Laitinen J et al.: Transanal or vaginal approach to rectocele repair: a prospective randomized pilot study. Dis Colon Rectum 2004; 47: 1636-42.[PubMed][Crossref]
- Kahn MA, Stanton SL: Techniques of rectocele repair and their effects on bowel function. Int Urogynecol J 1998; 9: 37-47.[Crossref]
- Kościński T, Skowrońska-Piekarska U: The results of the surgical treatment of severe constipation in own material. Gastroenterola Pol 2004; 11: 545-50.
- Kościński T, Drews M: Rectocele. An underestimated and unrecognized problem. Gastroenterol Pol 1999; 6: 139-42.
- Mellgren A, Johanson C, Dolk A: Enterocele demonstrated by defecography is associated with their other pelvic disorders. Int J Colorectal Dis 1994; 9: 121-24.[Crossref]
- Sullivan ES, Longaker CJ, Lee PYH: Total pelvic mesh repair. A ten-year experience. Dis Colon Rectum 2001; 44: 857-63.[Crossref]
- Escribano J, Furio MJ, Cuesta JA et al.: Transvaginal mesh perineal repair of the rectovaginal septum in the treatment of rectocele and enterocele. Outcomes in 77 patients. Cir Esp 2006; 79: 108-13.
- Peters WA, Smith MR, Drescher CW: Rectal prolapse in women with other defects of pelvic floor support. Am J Obstet Gynecol 2001; 184: 1488-94.
- Arhan P. Devroede G, Jehannin B: Segmental colonic transit time. Dis Colon Rectum 1981; 24: 625-29.[Crossref][PubMed]
- Marti MC, Mirescu D: Utilite du defecogramme en proctologie. Ann Gastroenterol Hepatol 1982; 18: 279-384.
- Shorven PJ, Mc Hugh S, Diament NE: Defecography in normal volunteers: results and implications. Gut 1989; 30: 1737-49.[Crossref]
- Goodrich MA, Webb MJ, King BF et al.: Magnetic resonance imaging of pelvic floor relaxation: dynamic analysis and evaluation patients before and after surgical repair. Obstet Gynecol 1993; 86: 883-91.
- Seyhaeve P, Brillirt J, Voaert P et al.: MR imaging of the pelvic floor. JRT-BTR 2006; 89: 182-89.
- Snooks SJ, Swash M, Henry MM et al.: Risk factors in childbirth causing damage to the pelvic floor innervation. Int J Colorectal Dis 1986; 1: 20-24.
- Sultan AH, Stanton SJ: Occult obstetric trauma and anal incontinence. Eur J Gastroenteral Hepatol 1997; 9: 423-27.[Crossref]
- Smith AR: Role of connective tissue and muscle in pelvic floor dysfunction. Curr Opin Obstet Gynecol 1994; 6: 317-19.[PubMed]
- De Vita D, Araco F, Gravante G et al.: Vaginal reconstructive surgery for severe pelvic organ prolapses: a "uterine-sparing" technique using polypropylene prostheses. Eur J Obstet Gynecol Reprod Biol 2008; 139: 245-51.[WoS]
- Azanjac B, Jorovic M: Transperineal repair of recurrent rectocele using polypropylene mesh. Tech Coloproctol 1999; 3: 39-41.[Crossref]
- Reisenauer C, Kirschniak A, Drews U et al.: Anatomical conditions for pelvic floor reconstruction with polypropylene implant and its application for treatment of vaginal prolapse. Eur J Obstet Gynecal Reprod Biol 2007; 13: 214-25.[WoS]
- Altman D, Falconer C: Perioperatve morbidity using transvaginal mesh in pelvic organ prolapse repair. Obstet Gynecol 2007; 109: 303-08.[WoS]
- De Tayrac R, Picone O, Chauveaud-Lambling A et al.: A 2-year anatomical and functional assessment of transvaginal rectocele repair using a polypropylene mesh. Int Urogynecology J 2006; 17: 100-05.[Crossref]
- Shak DK, Paul EM, Rastinehad AR et al.: Shortterm outcome analysis of total pelvic reconstruction with mesh: the vaginal approach. J Urol 2004; 171: 261-63.
- Elmer C, Altman D, Eugh ME et al.: Nordic Transvaginal Mesh Group. Trocar-guided transvaginal mesh repair of pelvic organ prolapse. Obstet Gynecol 2009; 113: 117-26.
- Zacharin RF: Abdomino-perineal repair of large pulsion enterocele. In: Zacharin RF. Pelvic floor anatomy and the surgery of pulsion enterocele. Springer, Wien-New York. 1985: 135-55.
- Collopy BT, Barham KA: Abdominal colporectopexy with pelvic cul-de-sac closure. Dis Colon Rectum 2002; 45: 522-29.[Crossref][PubMed]
- Watson SJ, Loder PB, Halligan S et al.: Transperineal repair of symptomatic rectocele with Marlex mesh: a clinical, physiological and radiological assessment of treatment. J Am Coll Surg 1996; 183: 257-61.
- Berglass S, Rubin IC: Histologic study of the pelvic connective tissue. Surg Gynecol Obstet 1957; 97: 277-89.
- Mercer-Jones MA, Sprowson A, Varma JS: Outcome after transperineal mesh repair of rectocele : a case series. Dis Colon Rectum 2004; 47: 864-68.[WoS]