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Transvaginal perineal body repair for low rectocele
1Academic Department of Surgery, St Vincent's Hospital Clinical School, University of New South Wales, Sydney, Australia. pp@kvinno.com
Insights
This study presents a novel low rectocele repair technique using a polypropylene sling to lift and approximate the perineal bodies (PBs). The method achieved over 90% cure rates, offering a precise repair for weakened PBs.
Area of Science:
- Pelvic floor reconstructive surgery
- Female pelvic medicine and reconstructive surgery
Background:
- Low rectocele involves thinning and lateral displacement of the perineal bodies (PBs), affecting the rectovaginal septum.
- This condition can result from childbirth injury and aging, impacting pelvic floor integrity.
Purpose of the Study:
- To describe a minimally invasive surgical technique for low rectocele repair.
- To evaluate the efficacy and outcomes of this novel approach.
Main Methods:
- A Tissue Fixation System with a polypropylene sling is used to approximate and lift laterally displaced PBs.
- Surgical technique involves dissecting PBs, creating tunnels for mesh insertion, and elevating PBs to a medial position.
- The procedure reinforces weakened PBs, creating a neo-central tendon through collagen infiltration.
Main Results:
- The described technique for low rectocele repair demonstrated a cure rate exceeding 90%.
- This method precisely mimics the damaged anatomical structures, differing from large-mesh repairs.
Conclusions:
- The described polypropylene sling technique offers a highly effective solution for low rectocele repair.
- This approach provides a targeted and minimally invasive option for restoring pelvic floor support.
Abstract:
We describe our technique of low rectocele repair which is based on the approximation and lifting of the laterally displaced perineal bodies (PBs) using the Tissue Fixation System, a 7-mm-wide tensioned macropore polypropylene sling. In low rectocele, the PB between the rectum and vagina is thinned and laterally displaced but still attached to the deep transverse perineal (DTP) muscle. Our technique is described with the aid of a video. The vagina and rectum are dissected off the laterally displaced PBs. The DTP attachment of each PB to the descending ramus is identified per rectum. A tunnel is created in the DTP on both sides to insert the polypropylene mesh attached to an anchor. The loop of tape between the anchors is shortened via the one-way system at the base of the anchor to elevate the inferolaterally displaced PBs to a more medial position. This is infiltrated by collagen over time, creating a "neo-central tendon." The musculofascial layer of the rectum, the vagina, and superficial layers of the PBs are approximated. Our cure rate for low rectocele repair was in excess of 90 %, even with an early version of this procedure. Our method differs from rectocele repair with large mesh in that it precisely mimics the damaged structure and uses only very short thin strips of tape to approximate and reinforce PBs weakened by birth injury and age.