New possibilities for reconstruction of the rectovaginal septum

Abstract

Introduction. One of the serious problems of the surgical treatment of the lowering and falling of femal reproductive organs, is a reconstruction of rectovaginal septum at presence of rectocele.

Full Text

Introduction. One of the serious problems of the surgical treatment of the lowering and falling of femal reproductive organs, is a reconstruction of rectovaginal septum at presence of rectocele. Levatoroplastics recommended in manual of the operative gynecology gives the good effect only in case of inferior rectocele, when hernial gates in rectovaginal septum are closed by levators contraction. The problem of reconstructions of rectovaginal septum in cases of the middle and superior rectocele remains open because of high frequency of relapse.

Material and methods. Pre-operative preparation of patients and the study of efficiency of the performed treatment included the standard clinical-laboratory examination, proctologic methods, denervation tests, prognostic methods (“stress”-tests), vaginodynamic investigations, USD, questionnaire of life quality. At the postoperative period there were conducted USD, overview X-ray of small pelvis, control proctologic and vaginodynamic methods, questionnaire of lives quality.

Results. In order to increase the efficiency of the operative treatment of the lowering and fallouts of the back vaginal wall with forming of rectocele, we used the net from the superelastic titanium-nickel threads. During the reconstruction of rectovaginal septum, we produced the broad preparaiting of the front rectal wall from back vaginal wall and adjoined fascia-muscular elements. Oversprained front rectal wall was taken in and brought back into natural anatomical borders. The net from the superelastic TiNi threads was put to restored front wall of vagina, prototyping on the form and fixed with separate stitches on the area from external sphincter of rectum to the back code of vagina with seizure of lateral walls. Then we sutured the slips of rectovaginal fascia, adjoined fascial-muscular elements. After excision of excesses of back vaginal wall, colpoperineorrhaphy with insulated levatoroplastics was produced.

In that way, 7 patients were operated with full and incomplete uterine prolaps with forming of rectocele. The age of the patients was 46-65 years. The postoperative period run without complications in all cases. The seams from perineum were taken away on the 6th-7th days. Healing of seams were primary. The control examinations after 4, 6, 12, 24, 36 months after operation showed that gynecologic, proctologic and sexual complaints, and the signs of the prolapse relapse were absent. The implantat did not show itself negatively. The data of USD and X-ray of small pelvis showed the usual structure of tissues around the implantat.

Conclusions. The results of the patients observation showed high efficiency of reconstructions of rectovaginal septum by reinforcing of the front rectal wall by means of the net from superelastic titanium-nickel threads. The designed methods can become the alternative to sacrovaginopexy in cases of complete forms of genital and front rectal wall prolaps.