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Evaluation of the Fascial Technique for Surgical Repair of Isolated Posterior Vaginal Wall Prolapse

From the Department of Obstetrics and Gynaecology, Royal Free and University College Medical School, London, United Kingdom.

Address reprint requests to: Kavita Singh, MRCOG, Royal Free and University College Medical School, Department of Obstetrics and Gynaecology, Rowland Hill, London NW3 2PF, United Kingdom; E-mail: kavita{at}rfhsm.ac.uk.

OBJECTIVE: To study the anatomic and functional efficacy and assess long-term success of the fascial technique in the repair of rectocele.

METHODS: Forty-two women with symptomatic posterior vaginal wall prolapse of at least stage II underwent a surgical repair using the technique of reconstruction of the rectovaginal septum. These women were evaluated at 6 weeks and 18 months postoperatively for anatomic improvement in the grade of their rectocele and a functional improvement in their vaginal, bowel, and sexual symptoms.

RESULTS: Ninety-five percent (40 of 42) were assessed at 6 weeks and 78.5% (33 of 42) attended follow-up at 18 months. Preoperative symptoms included 1) vaginal protrusion (78%); 2) defecation symptoms (76%), which included fecal incontinence alone in 9.5%, evacuation difficulties in 57%, and both fecal incontinence and evacuation difficulties in 9.5%; and 3) sexual dysfunction (33%). At 6-week follow-up there was resolution of vaginal protrusion in 87.5%, and bowel symptoms in 87%. At 18 months there was anatomic cure in 92%, improvement in defecation in 81%, and improvement of sexual dysfunction in 35%. No major complications were seen.

CONCLUSION: This technique is effective in providing relatively long anatomic cure of the rectocele and resolution of its symptoms.

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