Abstract:Rectovaginopexy provides significant one-year improvement of both constipation and fecal incontinence. The positive effect on constipation did not deteriorate with time, in contrast to the effect on fecal incontinence.
“…In the present study, preoperative defecography revealed anterior rectocele in 8 patients, whereas after surgery an actual rectocele was found in 6 patients ( p = 0.5). In contrast, in a prospective study including 20 patients with anterior rectocele, Silvis and co‐workers observed not only smaller rectoceles after rectovaginopexy in 3 patients but also complete anatomical correction in 13 cases [28]. However, as a transabdominal approach does not show any superiority over a transperineal, transvaginal, or endorectal approach concerning rectoceles, it might be associated with higher morbidity.…”
Resection rectopexy is a reliable method for treating rectal prolapse and rectoanal intussusception with clear improvement of the patient's clinical symptoms. The restored anorectal function can be attributed to improved rectal compliance, a lower sensory threshold, an elevation of the pelvic floor during squeezing, and an improved rectal evacuation.
“…In the present study, preoperative defecography revealed anterior rectocele in 8 patients, whereas after surgery an actual rectocele was found in 6 patients ( p = 0.5). In contrast, in a prospective study including 20 patients with anterior rectocele, Silvis and co‐workers observed not only smaller rectoceles after rectovaginopexy in 3 patients but also complete anatomical correction in 13 cases [28]. However, as a transabdominal approach does not show any superiority over a transperineal, transvaginal, or endorectal approach concerning rectoceles, it might be associated with higher morbidity.…”
Resection rectopexy is a reliable method for treating rectal prolapse and rectoanal intussusception with clear improvement of the patient's clinical symptoms. The restored anorectal function can be attributed to improved rectal compliance, a lower sensory threshold, an elevation of the pelvic floor during squeezing, and an improved rectal evacuation.
“…Many abdominal and perineal techniques have been described, differing mainly in the extent of rectal mobilisation, rectal fixation methods, and the inclusion or exclusion of bowel resection [ 15 , 17 – 20 ]. The potential advantage of abdominal procedures is fixation of the rectum in a more appropriate anatomic location without sacrifice of the compliant rectal reservoir.…”
Section: Discussionmentioning
confidence: 99%
“…All patients underwent a rectovaginopexy, a technique with the objective of avoiding damage to the hypogastric plexus and pelvic autonomic nerves by dissection of the peritoneum only, without mobilization of the dorsolateral side of the rectum and with preservation of the lateral ligaments (Fig. 3 ) [ 15 ]. Fig.…”
Robotic systems may be particularly supportive for procedures requiring careful pelvic dissection and suturing in the Douglas pouch, as in surgery for rectal prolapse. Studies reporting robot-assisted laparoscopic rectovaginopexy for rectal prolapse, however, are scarce. This prospective cohort study evaluated the outcome of this technique up to one year after surgery. From January 2005 to June 2006, 15 consecutive patients with a rectal prolapse, either with or without a concomitant rectocele or enterocele, underwent robot-assisted laparoscopic rectovaginopexy with support of the da Vinci robotic system. A prospective cohort study was performed on operating times, blood loss, intra-operative and post-operative complications, and outcome at a minimum of one year after surgery. Median age at time of operation was 62 years (33–72) and median body mass index 24.9 (20.9–33.9). Median robot set-up time was 10 min (3–15) and median skin-to-skin operating time was 160 min (120–180). No conversions to open surgery were necessary. No in-hospital complications occurred and there was no mortality. Median hospital stay was four days (2–9). During one year follow-up, two patients needed surgical reintervention. One patient was operated for recurrent enterocele and rectocele one week after surgery. In another patient an incisional hernia at the camera port occurred three months after surgery. At one year after surgery, 87% of patients claimed to be satisfied with their postoperative result. Robot-assisted laparoscopic rectovaginopexy proved to be an effective technique with favourable outcomes in most patients in this prospective series. The operating team experienced the support of the robotic system as beneficial, especially during the dissection of the rectovaginal plane and suturing in the Douglas pouch.
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