Rectocele plication: description of a novel surgical technique and review of clinical results

Abstract

A rectocele is the bulging of the anterior rectal wall into the posterior vaginal compartment. The route of surgical repair can be transvaginal, transrectal or abdominal. The aim of this retrospective study is to describe a novel transvaginal surgical procedure and investigate the associated subjective and objective clinical outcomes. Database records were retrieved for all women who underwent a rectocele plication for the period from January 2010 until December 2015 in a referral urogynecology unit with a minimum follow-up period of 12months. This transvaginal technique entails a plication of the anterior rectal wall by suturing of the rectal muscularis layer. Clinical findings and quality of life (QOL) metrics were evaluated and reported on. One hundred thirty-nine women met the initial inclusion criteria with full data available for 123. The presenting symptoms included a vaginal bulge in 73 (52.5%), overactive bladder (OAB) in 73 (52.5%), obstructed defecation (OD) in 49 (35.3%) and anal incontinence (AI) in 35 (25.2%). The majority of women (n=72, 51.8%) had stage 3-4 posterior prolapse. The mean follow-up period was 27±15months. The postoperative symptoms were significantly improved for all, except AI (p=0.43). There was a significant improvement in posterior prolapse (p<0.001) with the majority of women noted to have a stage 0 or 1 (n=109; 88.6%) posterior prolapse at follow-up. The rectocele plication is a novel surgical technique with good subjective and objective clinical outcomes in the medium term.