Abdominal sacrocolpopexy and anatomy and function of the posterior compartment

Objective: To assess the effect of abdominal sacrocolpopexy with obliterati on of the pouch of Douglas on anatomy and function of the posterior compart ment. Methods: We prospectively studied 33 consecutive women with pelvic organ pr olapse who had abdominal sacrocolpopexies [expanded polytetrafluoroethylene (Gore-Tex)] with pouch of Douglas obliterations and posterior extensions o f mesh, using a standardized questionnaire, urodynamic studies, pelvic floo r fluoroscopies, and vaginal-rectal examinations (Baden-Walker classificati on). Concomitant colpoperineorrhaphy was done if rectoceles remained at rec tovaginal examination at the end of sacrocolpopexy. The goal was to correct rectoceles transabdominally. Results: Thirty-one women returned for follow-up investigations after 12-48 months (mean 26 months). Mean age was 61 years (range 41-77 years). There was no recurrence of vaginal vault prolapse, enterocele, or anterior rectal wall prolapse. Among 28 preoperative rectoceles, 16 recurred (57%) and one occurred de novo. Defecation problems (outlet constipation) were present i n 21 women (64%) preoperatively and persisted or were altered in 12 (57%) a fter sacrocolpopexy. Grade of rectocele was associated significantly with s ymptoms of outlet constipation preoperatively, but not postoperatively (P = .002). Conclusion: Abdominal sacrocolpopexy with obliteration of the pouch of Doug las and posterior extension of the mesh was effective for vaginal vault pro lapse, enterocele, and anterior rectal wall procidentia, but not concomitan t rectocele. Twenty-eight percent of women described altered defecation wit h stool stopping higher in the rectosigmoid colon ("high outlet constipatio n"), which might have been caused by denervation during rectal mobilization . (Obstet Gynecol 2001;97:678- 84. (C) 2001 by The American College of Obst etricians and Gynecologists.).