Abdominal rectovaginopexy - Modified technique to treat constipation

PURPOSE: We noted the combination of obstructed defecation or constipation and fecal incontinence, the poor results of abdominal rectopexy for constip ation, and the well-known risk of postoperative induction of constipation a fter rectopexy. We developed a new operation to treat patients with constip ation or fecal incontinence (with a concomitant rectocele, internal rectal intussusception, enterocele at dynamic defecography, or all three) or both. This new rectopexy technique avoided dorsolateral mobilization of the rect um and did not endanger the hypogastric nerves and pelvic autonomic nerves. A better effect on constipation compared with rectopexies with dorsolatera l mobilization was expected. METHODS: The results of this new operation, wh ich was called rectovaginopexy, were studied prospectively in a series of 2 7 patients. Four-year results were obtained. Preoperative and postoperative questionnaires, dynamic defecograms, and anorectal physiology studies were analyzed. RESULTS: Before the operation 17 patients were constipated, comp ared with 4 patients one year after rectovaginopexy (76 percent improvement ; P = 0.0015) and 5 patients four years after rectovaginopexy(71 percent im provement; P = 0.005), respectively. At one year, fecal incontinence decrea sed significantly: 15 of 17 patients improved and 9 patients became fully c ontinent (P = 0.0007). Four years after rectovaginopexy the effect on fecal incontinence was no longer significant (P = 0.09). Rectovaginopexy restore d anatomy: all (9) enteroceles, all but 1 (17) internal rectal intussuscept ion, and 12 of 20 rectoceles dissolved, and the majority were reduced in si ze. Rectal sensation for distention was unchanged, and rectal electrosensit ivity improved (P = 0.04). CONCLUSIONS: Rectovaginopexy provides significan t one-year improvement of both constipation and fecal incontinence. The pos itive effect on constipation did not deteriorate with time, in contrast to the effect on fecal incontinence.