Midline Rectovaginal fascial plication for repair of rectocele and obstructed defecation

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 H 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 [010.83-1.00%) 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% (950% 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, resp, ctively (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, harc stools, and dyspareunia (P =.001). The improved anatomical and functional outcomes were reflected in die fact that 97% of the women reported very high patient satisfaction. CONCLUSION: Nhdline fascial plication is effective in correcting anatomical and functional outcomes associated with symptomatic rectoceles and obstructed defecation. ((C) 2004 by The American College of Obstetricians and Gynecologists.).