Midline rectovaginal fascial plication for repair of rectocele and obstructed defecation

Maher, C. F., Qatawneh, A. M., Baessler, K. and Schluter, P. J. (2004) Midline rectovaginal fascial plication for repair of rectocele and obstructed defecation. Obstetrics and Gynecology, 104 4: 685-689. doi:10.1097/01.AOG.0000139833.48063.03

Author Maher, C. F.
Qatawneh, A. M.
Baessler, K.
Schluter, P. J.
Title Midline rectovaginal fascial plication for repair of rectocele and obstructed defecation
Journal name Obstetrics and Gynecology   Check publisher's open access policy
ISSN 0029-7844
Publication date 2004
Sub-type Article (original research)
DOI 10.1097/01.AOG.0000139833.48063.03
Volume 104
Issue 4
Start page 685
End page 689
Total pages 5
Editor J. R. Scott
Place of publication United States
Publisher Lippincott Williams and Wilkins
Collection year 2004
Language eng
Subject C1
321014 Obstetrics and Gynaecology
730115 Urogenital system and disorders
Abstract 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
Q-Index Code C1

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Created: Wed, 15 Aug 2007, 05:05:05 EST