VAGINAL REPAIR OF RECTOCELE AFTER DYNAMIC GRACILOPLASTY FOR FECAL INCONTINENCE DUE TO IMPERFORATE ANUS

A 35 years old woman developed obstructed defecation due to a large (6 cm) non-emptying rectocele one year after successful electrostimulate d gracilis neosphincter operation for correction of fecal incontinence after surgery for imperforate anus. Surgical correction of the rectoc ele was performed by a trans-vaginal approach due to the poor elastici ty of the neoanus and avoidance of possible damage to the neosphincter . After physiological investigations, including defecography, the pati ent had a resection of the posterior vaginal mucosal wall, a double la yer plication of the muscular wall with non-absorbable suture and a lo ngitudinal mucosal suture. The postoperative course was uneventful. De fecography, performed 3 and 6 months later, showed a marked reduction of the rectocele (2 cm) which corresponded to clinical improvement. Oc currence of disabling rectocele can be considered a possible long term complication after successful electrostimulated neosphincter procedur e in patients at risk for developing a rectocele; a successful rep air can be obtained using trans-vaginal approach without the risk of neos phincter damage. Transvaginal repair of rectocele in similar clinical situations may be recommended.