Surgical Repair of Rectocele – Case Report

Abstract

Background

Rectocele is the herniation of the rectum through the posterior wall of the vagina due to the loss of integrity of the rectovaginal fascia. Many parous women have a sort of pelvic organ prolapse, though most of the time this is asymptomatic. Over time, as the defect becomes larger, the patient may complain of constipation, difficult defecation, pelvic pain, mucosal erosion and the presence of a visible bulge. Among treatment options, dietary and lifestyle changes are recommended, medications, devices such as vaginal pessaries and surgical procedures.

Case presentation

Our 60 years old female patient was diagnosed 7 years before with rectocele. On the last 2 months it had reached considerable dimesions (grade III-IV). She complained of difficulty in urination and had a urinary catheter placed. The surgical procedure was proposed and patient consent obtained. A posterior colpo-perineorraphy was performed, without mesh placement. The patient made a full recovery and was discharged.

Discussion

The initial treatment of rectocele starts with the modification of the risk factors and relief of obstructive defecation syndrome. Patients are prescribed osmotic laxatives along with dietary changes for more fibre intake. Usage of pessaries, space occupying vaginal devices may be of help in select patients and it should be mentioned as a therapeutic alternative, though care must be taken to ensure proper usage as mucosal damage has been reported. The patients with severe and symptomatic rectocele should undergo a surgical intervention. From the list of possible approaches, we can mention: a) posterior colporraphy with the reinforcing of the rectovaginal septum, with or without the placement of a reinforcing prosthetic mesh. Some studies report higer recurrence rates where mesh was applied; b) transanal plication; c) transanal resection; d) abdominal suspension. Ultimately each of the procedures comes with the associated risks.

Conclusion

To conclude, it is the decision of the surgeon to find the best surgical approach for the treatment of rectocele. Not only he should be comfortable with the procedure, but care should be taken to achieve the full relief of the symptoms of the patient. For this specific case, due to the higher stage of rectocele, a posterior colporraphy, with the transvaginal plication of rectovaginal septum was chosen as a safe and efficient surgical approach.

Keywords: General Surgery, Rectocele, Perineum, Pelvic Floor, Colpo-perineorraphy, Colporraphy.

DOI: 10.7176/JEP/14-32-05

Publication date: November 30^th 2023