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Transverse incision transvaginal rectocele repair combined with levatorplasty and biological graft insertion: technical details and case series outcomes

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Abstract

Background

The purpose of this report is twofold: first, to detail our operative approach to rectocele repair, and second, to report on the outcomes.

Methods

Transverse incision transvaginal rectocele repair combined with levatorplasty and biological graft placement is detailed using hand-drawn sketches and intraoperative photographs. All patients with symptoms of functional constipation and non-emptying rectocele operated on from May 2007 to March 2013 at our institution were enrolled in this study. Data from a prospectively maintained database were retrospectively analyzed. Preoperative and postoperative functional outcomes were studied using a validated 31-point obstructed defecation (OD) scoring system. Follow-up was 1 year.

Results

Twenty-three patients underwent the procedure. The mean age of patients was 55 years (range 28–79 years). The OD severity score improved from the preoperative mean of 21.6 to postoperative mean of 5.5 (p = 0.001). Three out of four patients with initial symptoms of dyspareunia (75 %) reported significant improvement in dyspareunia, while 2 out of 19 patients without initial symptoms of dyspareunia (11 %) reported mild dyspareunia following the repair. One patient (4 %) required operative drainage of a hematoma. Another patient (4 %) developed symptomatic recurrence which was confirmed radiologically.

Conclusions

In properly selected patients, the technique described leads to significant improvement in symptoms of OD and low recurrence without an increased rate of dyspareunia.

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Acknowledgments

We would like to thank Mrs. Suela Sulo from Russell Research Institute at Advocate Lutheran General Hospital for her support with the institutional review board application and Fellowship Foundation for sponsoring the Minimally Invasive Research Fellowship at Advocate Lutheran General Hospital/University of Illinois at Chicago.

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Authors and Affiliations

  1. Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, University of Illinois at Chicago, 1775 Dempster St., Park Ridge, IL, 60068, USA

    G. Melich, A. Pai, M. Kwak, S. Bibi, S. Marecik, J. Park & L. M. Prasad

  2. Department of Surgery, Royal Columbian Hospital, University of British Columbia, 330 E Columbia St., New Westminster, BC, V3L3W7, Canada

    G. Melich

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  1. G. Melich
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Correspondence to G. Melich.

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The authors declare that they have no conflict of interest.

Ethical approval

Institutional review board approval was obtained.

Informed consent

Patients informed consent to the treatment was obtained. The series is consistent with 1964 Helsinki declaration and its amendments.

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Melich, G., Pai, A., Kwak, M. et al. Transverse incision transvaginal rectocele repair combined with levatorplasty and biological graft insertion: technical details and case series outcomes. Tech Coloproctol 20, 51–57 (2016). https://doi.org/10.1007/s10151-015-1399-x

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