Treatment of enterocele by abdominal colporectosacropexy – efficacy on pelvic pressure

Abstract

OBJECTIVE: Enterocele induces pelvic pressure, obstructed defaecation, lower abdominal pain and/or false urge to defaecate in patients. The aim of this study was to evaluate the efficacy of abdominal colporectosacropexy in these symptoms, especially on pelvic pressure. METHODS: Sixty-two consecutive women with enterocele were included. All patients were symptomatic because they had: pelvic pressure (n = 62), obstructed defaecation (n = 40), lower abdominal pain (n = 8) or faecal incontinence (n = 16). Defaecography confirmed enterocele in all patients. The surgical procedure was performed by the same surgeon and was an abdominal colporectosacropexy with a nonabsorbable Prolene(R) mesh. After surgery, clinical evaluation (62/62 patients) and a telephone questionnaire (56/62 patients) were performed, respectively, 3 months and 27 +/- 13 months after surgery. RESULTS: Defaecography showed rectal abnormalities associated with enterocele in 59/62 patients (rectocele, rectal prolapse). No recurrence of enterocele was observed 3 months after surgery, but 1 patient demonstrated recurrence 10 months after surgery. Pelvic pressure was less frequent after abdominal colporectosacropexy, than before surgery (P < 0.01): pelvic pressure totally disappeared in 41/56 patients, and partially in 10/56 patients. The number of patients with obstructed defaecation, lower abdominal pain, or faecal incontinence was not different before and 27 months after surgery. The number of patients with urinary incontinence was also not different before and after surgery (30 and 27 patients). CONCLUSIONS: This study of a large number of patients with enterocele shows that abdominal colporectosacropexy improves pelvic pressure in most patients and does not modify urinary status.

Laparoscopic ventral rectopexy for obstructed defecation syndrome

“…In the case of an isolated mechanical outlet obstruction, which can be the result of a second-or third-degree enterocele, treatment of this cele by abdominal pexy can be efficacy on pelvic pressure but not on obstructed defecation [13]. This is confirmed by findings in an earlier study by Orrom et al, in which they conclude that rectopexy, by posterior or combined anterior and posterior fixation, can result in a significant amelioration of symptoms of obstructed defecation during initial follow-up, but during the time many patients reported even worsening of complaints as reflected by an increase in tenesmus, stool frequency and incomplete emptying [14].…”

Long-Term Follow-Up of Simultaneous Abdominoperineal Repair of Enterorectocele and Internal Mucosal Prolapse

“…27,28 Given that most patients still have evacuation problems after enterocele repair, 6,13 enterocele is unlikely to be a main cause of obstructed defecation. However, some authors do report an improvement in defecation after resection or colporectosacropexy, 29 indicating that enterocele may be the cause of constipation in some cases.…”

Dynamic pelvic three-dimensional computed tomography for investigation of pelvic abnormalities in patients with rectocele and rectal prolapse

“…[11][12][13][14] Rectocele and rectal prolapse can be readily diagnosed by clinical and defecographic findings, but invasive studies such as defecography combined with peritoneography have been required to diagnose accompanying enteroceles or sigmoidoceles. 12,13,15 Recent progress in diagnostic imaging techniques has facilitated the dynamic assessment of such abnormalities with dynamic MRI [6][7][8] or multislice CT. 10 To date, defecography has played a major role in the morphological evaluation of patients with defecation disorders, but it does not always explain all clinical findings. Its limitations have been overcome by simultaneous performance of peritoneography to evaluate surrounding structures.…”