Surgical Correction of Obstructed Defecation Syndrome

Abstract

Video Objective Obstructed defecation syndrome (ODS) is a form of colonic constipation in which stool cannot effectively be evacuated from the rectum. ODS is usually caused by a combination of behavioral, functional, and anatomic factors. While many women with ODS can experience improvement with aggressive medical management, the anatomic contribution what we term a “posterior” enterocele to defecation obstruction can be significant. Setting We present a video description of anterior rectopexy at the time of sacrocolpopexy with obliteration of the rectovaginal space to address posterior compartment prolapse as a cause of outlet constipation. Interventions To date, we have completed 12 procedures with resolution of ODS in all subjects. With 6-12 months of post-operative follow up, there have been no operative complications and no recurrent posterior enterocele. One subject had recurrent rectal mucosal prolapse. Prospective data collection is still ongoing. Conclusion The modification to sacrocolpopexy presented in this video seeks to address ODS by obliterating the rectovaginal space. Traditional sacrocolpopexy does not effectively address this defect and small bowel continues to herniate behind the posterior vaginal mesh.