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Abstract
BACK GROUND:
Rectocele is one of the most distressing conditions related to multiple vaginal deliveries. A rectocele is a herniation of the anterior rectal wall into the vaginal cavity and at times through the vaginal introitus.This anatomic distortion results from loss of the integrity of the intervening rectovaginal fascia.
OBJECTIVES:
The aim of the present work is to compare the outcome of two surgical methods used in rectocele repair.
METHODS:
The study subjects included 40 women,who had no gynecologic disorders other than rectocele. Patients with recurrent rectocele were excluded.
Women were assigned for surgical repair when a symptomatic rectocele was confirmed and were randomly allocated into two groups according to technique of surgical repair .
Group (I): 20 patients subjected to classical posterior colpoperineorrhaphy, according to Hegar-Halban(1870)levator plication operation.
Group (II): 20 patients subjected to full length posterior vaginal wall reconstruction of the rectovaginal septum using prolene mesh.
All patients were subjected to preoperative preparations of vaginal operations including routine laboratory investigations including complete urine analysis, haemoglobin percent and blood count, fasting blood sugar level, bleeding, clotting times and prothrombin time and activity. Surgery was performed on all patients and notes were taken for each patient during and after operation at the first of the week, 1st , 3rd and months post-operatively.
RESULTS:
The main results obtained from this work were as follows :
The age of these patients ranged from 30-50 years.
B. All 40 cases had normal vaginal deliveries.
C. All patients had symptoms caused by rectocele before operation , symptoms attributable to the condition included protrusion, sexual dysfunction and rectal complaint.
D. Sexual dysfunction was in the form of deep dysparunia, heaviness, a sensation of burning and block during intercourse.
E. There was no significant difference between the time taken to complete the operatipon for group (I) and group (II), were group (I) cases (classical operation) needed more time than group (II) cases (new operation).
F. All symptoms of rectocele in both groups such as assisted manual evacuation, dyschasia, dysparunia, heaviness and block sensation in addition to recurrence were improved in group (II) of the new opertion by a significant difference than in group (I), of the classical operation, except in case of constipation where there was no significant difference.
G. 3 cases of group (I) showed recurrence of rectocele at the end of the sith month postoperatively while no recurrence was detected among group (II) patients.
H. 2 cases of group II showed delayed mesh erosion which required removal of the eroding part of the mesh surgicaly. No mesh was removed totally.
CONCLUSIONS
This study is among the few surgical outcome reports of any technique of rectocele repair. It is probable that no single technique can correct all rectoceles because of their diverse anatomic and functional components. Heaviness and mass protruding from the vagina, dysparunia and dyschasia are the most common associated complains of patients with rectocele. Development of a fibrous layer supporting the rectovaginal septum through implication of a prolene mesh over the septum , using tension free sutures ,without plication of the two levators may be the secret of the better results obtained in patients of group (II)., in which there was significant improvement of the symptoms compared to the classical operation after six months follow up. The new operation needs longer time to complete.