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Midline Rectovaginal Fascial Plication for Repair of Rectocele and Obstructed Defecation

Christopher F. Maher, FRANZCOG^*, Aymen M. Qatawneh, MD^*, Kaven Baessler, MD^* and Philip J. Schluter, PhD

From the *Urogynaecology Unit, Royal Women's and Mater Hospitals, Brisbane; and School of Population Health, University of Queensland, Brisbane, Australia.

Address reprint requests to: Christopher Maher, Suite 86, 30 Chasely Street, Auchenflower, 4066, Brisbane, Queensland, Australia; e-mail: chrismaher{at}urogynaecology.com.au.

OBJECTIVE: To estimate the efficacy of midline fascial plication of the posterior vaginal wall in women with rectoceles and obstructed defecation.

METHODS: Prospective evaluation of 38 consecutive women with symptomatic rectoceles (stage II or greater) and obstructed defecation included pre- and postoperative standardized pelvic floor questions, pelvic organ prolapse quantification measurements, validated bowel function questionnaires, defecating proctogram, and patient satisfaction. Reviews were conducted by nonsurgical coauthors.

RESULTS: The median follow-up was 12.5 months (range 2.5–26 months). The subjective success rates were 97% (95% confidence interval [CI] 0.83–1.00%) at 12 months and 89% (95% CI 0.55–0.98%) at 24 months. The objective success rates were 87% (95% CI 0.64–0.96%) at 12 months and 79% (95% CI 0.51–0.92%) at 24 months. The average points, Ap and Bp, were significantly reduced from –0.1 (range –2 to 3) and 1.1 (range –1 to 8), preoperatively, to –2.6 (range –3 to –1) and –2.5 (range –3 to 0), postoperatively, respectively (P < .001). Depth of rectocele also reduced postoperatively on defecating fluoroscopy (P < .001). The correction of the anatomical defect was associated with improved functional outcome, with 33 women (87%) no longer experiencing obstructed defecation, and there was a significant reduction in postoperative straining to defecate, hard stools, and dyspareunia (P = .001). The improved anatomical and functional outcomes were reflected in the fact that 97% of the women reported very high patient satisfaction.

CONCLUSION: Midline fascial plication is effective in correcting anatomical and functional outcomes associated with symptomatic rectoceles and obstructed defecation.

LEVEL OF EVIDENCE: III

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