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The authors conducted a review of the medical charts of all patients between July 1998 and June 2002 who had undergone repair of advanced posterior vaginal prolapse and had at least 1 year of follow up. They identified 124 consecutive patients who had undergone site-specific rectocele repair and 183 consecutive patients who had standard posterior colporrhaphy without levator ani plication. This paper presents a comparison of patient outcomes from each of these procedures.A standard method was used for posterior colporrhaphy with no plication of the levator ani. In the site-specific procedure, the dissection to the rectovaginal septum was extended laterally to the arcus tendineus levator ani muscles and inferiorly to the perineal body, leaving an avascular plane of endopelvic connective tissue on the rectum. At this point, specific defects in the Denonvilliers' fascia were identified with the surgeon's finger in the patient's rectum. Using Allis clamps, connective tissues were pulled together over the defect and sutured using interrupted 0 polygalactin 910 sutures.There were no significant differences in patient characteristics or operative data between the 2 groups, but there were significant differences in rates of recurrence. Recurrence of posterior vaginal prolapse beyond the midvaginal plane (33% vs. 14%, P ϭ .001) or recurrence beyond the hymenal ring (11% vs. 4%, P ϭ .02), and recurrence of a symptomatic bulge (11% vs. 4%, P ϭ .02) were significantly more common among the patients who underwent site-specific repair compared with those who had posterior colporrhaphy. Also, the mean postoperative Bp point was significantly higher in the site-specific group (Ϫ2.2 vs. Ϫ2.7, P ϭ .001).The percentage of patients with dyspareunia before and after surgery for vaginal prolapse increased significantly (8% vs. 17%, P ϭ .001). Postoperative reports of constipation, diarrhea, abdominal pain, fecal incontinence, and flatus incontinence remained essentially unchanged from preoperative rates. There were no significant differences in pre-and postoperative symptoms, including dyspareunia, between the 2 groups. Rates of de novo occurrence and improvement of symptoms were similar in both groups. GYNECOLOGYVolume 60, Number 5 OBSTETRICAL AND GYNECOLOGICAL SURVEY ABSTRACTThe "see and treat" method of cervical screening combines the diagnosis and treatment of premalignant cervical abnormalities by performing a loop electrosurgical excision procedure (LEEP) during the initial screening visit. Because 298Obstetrical and Gynecological Survey

2016-11-15T19:40:59

No abstract