Clinical, physiological and radiological assessment of rectovaginal septum reinforcement with mesh for complex rectocele

Abstract

Abstract Background Rectocele can be part of a more complex rectal prolapse syndrome including rectal intussusception and enterocele. This reflects insufficiency at different levels of support in the posterior pelvic compartment. A new technique involving reinforcement of the rectovaginal septum with mesh by a combined laparoscopic and perineal approach was evaluated. Methods The study included 18 patients with a complex rectocele and grade 2–3 rectal intussusception and enterocele (eight patients). Patients had clinical, physiological and radiological follow-up. Results There was no major perioperative morbidity and mean hospital stay was 4·5 (range 3–7) days. After a mean of 24·2 (range 13–35) months there was no clinical recurrence of rectocele. Symptoms of obstructed defaecation resolved in 14 of 17 patients. The Patient Assessment of Constipation Symptoms score decreased from a mean(s.d.) of 12·6(5·9) to 3·9(4·2), and a rectocele symptom score from 14·3(3·3) to 2·3(2·8). No new-onset constipation, urge or faecal incontinence nor new-onset dyspareunia was reported. Radiological investigation in eight patients revealed a sufficient anatomical repair at the different levels of support. A slight decrease in rectal compliance was measured, with no significant reduction in rectal capacity. Conclusion Complete rectovaginal septum reinforcement with mesh corrected complex rectoceles, with good functional outcome.