Sj. Watson et al., TRANSPERINEAL REPAIR OF SYMPTOMATIC RECTOCELE WITH MARLEX MESH - A CLINICAL, PHYSIOLOGICAL AND RADIOLOGIC ASSESSMENT OF TREATMENT, Journal of the American College of Surgeons, 183(3), 1996, pp. 257-261
BACKGROUND: The aim of this study was to evaluate the operative repair
of rectoceles in a defined group of women by a technique designed to
deal with the cause (failure of the rectovaginal septum) rather than t
he effect (rectal and vaginal wall bulging). STUDY DESIGN: Only women
whose defecation was aided by vaginal digitation and who had large rec
toceles on proctography were included. Any other clinical symptoms in
the absence of vaginal digitation, even when proctography demonstrated
a rectocele, were not taken as indicators for surgery in this study.
There were nine women, median age 50 years (range, 32 to 61). The rect
ovaginal septum was repaired with Marlex mesh through a perineal appro
ach by one surgeon. The median followup period was 29 months. RESULTS:
Eight of the nine women achieved successful evacuation after surgery
without the need for vaginal digitation. Rectocele size, depth, and th
e percent of barium trapped in the rectocele on proctography were all
improved. Anorectal physiology measurements were unchanged by surgery.
CONCLUSIONS: Operative repair of the rectovaginal septum removes the
need for vaginal digitation in most women with large rectoceles on pro
ctography, Further studies in well-defined groups of women are needed
to establish how well rectocele repair aids women with a variety of ot
her pelvic and perineal symptoms.