Surgical interventions for posterior compartment prolapse and obstructed defecation symptoms: a systematic review with clinical practice recommendations

Grimes, Cara L.; Schimpf, Megan O.; Wieslander, Cecilia K.; Sleemi, Ambereen; Doyle, Paula; Wu, Yingru; Singh, Rashmi B. Halker; Balk, Ethan M; Rahn, David D.

doi:10.1007/s00192-019-04001-z

Cited by 26 publications

(25 citation statements)

References 57 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…9 A recent systematic review, after reviewing studies that included six different surgical techniques (abdominal, vaginal and trans-anal ones) concluded that "for women with rectocele and symptoms of obstructed defecation, who require surgery, a transvaginal posterior colporrhaphy with native tissues should be considered the first approach to improve the anatomy and symptoms, despite the greater risk of dyspareunia when compared to other techniques". 10 The differential of the technique we have described herein, when compared to those previously described, mainly for rectocele repair, is the lateral and cranial rectal dissection, with extra mucosal repair of the rectum and its elongation and luminal reduction, thus correcting the intussusception and prolapse (after all, the damage is extramucosal and therefore the repair must also be). A specific repair of the rectum is performed, with better reconstruction of its anatomy.…”

Section: Discussionmentioning

confidence: 99%

Repair of the middle and posterior compartments of the pelvic floor via perineal and vaginal routes without the use of mesh - technique description and case series

Nogueira

Macedo

Leite

2020

Journal of Coloproctology

View full text Add to dashboard Cite

Introduction Currently, problems such as constipation due to outlet obstruction, rectal/vaginal prolapse and fecal and urinary incontinence have become increasingly more frequent because of the population aging process, with great impact on the quality of life. Objective To describe a technique for surgical repair of middle/posterior pelvic floor compartments and extra-mucosal rectal wall treatment by transperineal and vaginal approach, using native tissues and present the results in twenty patients submitted to this surgical technique. Method Patients with symptoms secondary to middle/posterior pelvic floor descent and anatomical changes confirmed by proctological exam and pelvic MRI defecography. Results were evaluated through the Agachan constipation score, using pre- and post-operative questionnaires. Results Immediate repair of rectocele and musculature, with prompt improvement of constipation, sustained by 42 months. There were no severe complications in the postoperative period. Conclusion This is an effective technique, with adequate anatomic repair, improvement of constipation scores and with low risk.

show abstract

Section: Discussionmentioning

confidence: 99%

Repair of the middle and posterior compartments of the pelvic floor via perineal and vaginal routes without the use of mesh - technique description and case series

Nogueira

Macedo

Leite

2020

Journal of Coloproctology

View full text Add to dashboard Cite

show abstract

“…Complications include dyspareunia, bleeding, and wound infection. In a meta-analysis native tissue transvaginal repairs are preferentially recommended over other repairs [29].…”

Section: Treatment Of Ods Due To Rectocele/ Enterocele/sigmoidocelementioning

confidence: 99%

Treatment of Difficult/Obstructive Defecation

Zutshi

Oliveira²

2021

The ASCRS Textbook of Colon and Rectal Surgery

View full text Add to dashboard Cite

Concepts • Obstructed defecation syndrome is a subtype of constipation wherein patients usually complain of straining; incomplete, unsuccessful, or painful evacuation; bowel infrequency; abdominal pain and bloating; and the possible need for digitation. • Initial management is lifestyle advice, laxatives, and bowel retraining programs, including biofeedback and psychological support. • Diagnostic testing may point to a diagnosis, but clinical correlation should always be used. • Dyssynergic defecation is a clinical diagnosis and requires knowledge of anatomy and physiology for management. • Patients with overt rectal or anterior compartment prolapse and symptoms of obstructed defecation should be managed surgically. • Rectoceles, when symptomatic, require a surgical option. • Enteroceles and sigmoidoceles need a multimodal approach for effective symptom relief.

show abstract

“…Different surgical techniques have been described to repair symptomatic rectocoeles 16–33 to reinforce the rectovaginal septum, and four different routes of access have been described, transvaginal, transperineal, transanal, and most recently abdominal. The transvaginal approach involves the incision of the posterior wall of the vagina through a longitudinal incision, transverse incision, or a combination of the two.…”

Section: Introductionmentioning

confidence: 99%

“…The most common complications after rectocoele repair, regardless of technique, are long‐term persistence of obstructed defecation or vaginal prolapse symptoms. Most common adverse outcomes are dyspareunia, 35–37 fecal urgency, 29 anal stenosis, 29 and mesh erosion 17–20 …”

Section: Introductionmentioning

confidence: 99%

Transvaginal rectocoele repair for the surgical treatment of a “symptomatic” rectocoele when conservative measures fail: A 12 year experience of 215 patients

Ferrari

Cuinas

Hainsworth

et al. 2022

Neurogastroenterology Motil

View full text Add to dashboard Cite

Background: Conservative measures are first-line treatment for a "symptomatic" rectocoele, while surgery to correct the anatomical defect may be considered in selected cases. The standard repair offered in our trust is a native tissue transvaginal rectocoele repair (TVRR) combined with levatorplasty. The primary aim of the study was to conduct a retrospective study to assess the outcome of this procedure, while secondary aims were to assess whether specific characteristics and symptoms were associated with response to surgery. Methods:We conducted a retrospective review of 215 patients who underwent TVRR in a single tertiary referral center between 2006 and 2018. In total, 97% of patients had symptoms of obstructive defecation syndrome (ODS) and 81% had a feeling of vaginal prolapse/bulge. We recorded in-hospital and 30 days post-operative complications and pre-and post-operative symptoms. Key results:The majority of patients selected for surgery had rectocoele above 4 cm or medium size with contrast trapping. Mean length of hospital stay was 3.2 days. The in-hospital complication rate was 11.2% with the most common complications being urinary retention (8.4%). Mean length of follow-up was 12.7 months (SD 13.9, range 1.4-71.5) with global improvement of symptoms reported in 87.9% cases. Feeling of vaginal bulge improved in 80% of patients while ODS-related symptoms improved in 58% of cases. Conclusions & inferences:The data suggest that TVRR might be a valid option in patients with rectocoele when conservative treatment has failed. Overall patient satisfaction is good, with improvement of ODS symptoms.

show abstract

Surgical interventions for posterior compartment prolapse and obstructed defecation symptoms: a systematic review with clinical practice recommendations

Cited by 26 publications

References 57 publications

Repair of the middle and posterior compartments of the pelvic floor via perineal and vaginal routes without the use of mesh - technique description and case series

Repair of the middle and posterior compartments of the pelvic floor via perineal and vaginal routes without the use of mesh - technique description and case series

Treatment of Difficult/Obstructive Defecation

Transvaginal rectocoele repair for the surgical treatment of a “symptomatic” rectocoele when conservative measures fail: A 12 year experience of 215 patients

Contact Info

Product

Resources

About