TY - JOUR
T1 - Abdominal rectovaginopexy
T2 - Modified technique to treat constipation
AU - Silvis, R.
AU - Gooszen, H. G.
AU - Van Essen, A.
AU - De Kruif, A. Th C.M.
AU - Janssen, L. W.M.
PY - 1999/1/1
Y1 - 1999/1/1
N2 - PURPOSE: We noted the combination of obstructed defecation or constipation and fecal incontinence, the poor results of abdominal rectopexy for constipation, and the well-known risk of postoperative induction of constipation after rectopexy. We developed a new operation to treat patients with constipation or fecal incontinence (with a concomitant rectocele, internal rectal intussusception, enterocele at dynamic defecography, or all three) or both. This new rectopexy technique avoided dorsolateral mobilization of the rectum and did not endanger the hypogastric nerves and pelvic autonomic nerves. A better effect on constipation compared with rectopexies with dorsolateral mobilization was expected. METHODS: The results of this new operation, which was called rectovaginopexy, were studied prospectively in a series of 27 patients. Four-year results were obtained. Preoperative and postoperative questionnaires, dynamic defecograms, and anorectal physiology studies were analyzed. RESULTS: Before the operation 17 patients were constipated, compared with 4 patients one year after rectovaginopexy (76 percent improvement; P = 0.0015) and 5 patients four years after rectovaginopexy (71 percent improvement; P = 0.005), respectively. At one year, fecal incontinence decreased significantly: 15 of 17 patients improved and 9 patients became fully continent (P = 0.0007). Four years after rectovaginopexy the effect on fecal incontinence was no longer significant (P = 0.09). Rectovaginopexy restored anatomy: all (9) enteroceles, all but 1 (17) internal rectal intussusception, and 12 of 20 rectoceles dissolved, and the majority were reduced in size. Rectal sensation for distention was unchanged, and rectal electrosensitivity improved (P = 0.04). CONCLUSIONS: Rectovaginopexy provides significant one-year improvement of both constipation and fecal incontinence. The positive effect on constipation did not deteriorate with time, in contrast to the effect on fecal incontinence.
AB - PURPOSE: We noted the combination of obstructed defecation or constipation and fecal incontinence, the poor results of abdominal rectopexy for constipation, and the well-known risk of postoperative induction of constipation after rectopexy. We developed a new operation to treat patients with constipation or fecal incontinence (with a concomitant rectocele, internal rectal intussusception, enterocele at dynamic defecography, or all three) or both. This new rectopexy technique avoided dorsolateral mobilization of the rectum and did not endanger the hypogastric nerves and pelvic autonomic nerves. A better effect on constipation compared with rectopexies with dorsolateral mobilization was expected. METHODS: The results of this new operation, which was called rectovaginopexy, were studied prospectively in a series of 27 patients. Four-year results were obtained. Preoperative and postoperative questionnaires, dynamic defecograms, and anorectal physiology studies were analyzed. RESULTS: Before the operation 17 patients were constipated, compared with 4 patients one year after rectovaginopexy (76 percent improvement; P = 0.0015) and 5 patients four years after rectovaginopexy (71 percent improvement; P = 0.005), respectively. At one year, fecal incontinence decreased significantly: 15 of 17 patients improved and 9 patients became fully continent (P = 0.0007). Four years after rectovaginopexy the effect on fecal incontinence was no longer significant (P = 0.09). Rectovaginopexy restored anatomy: all (9) enteroceles, all but 1 (17) internal rectal intussusception, and 12 of 20 rectoceles dissolved, and the majority were reduced in size. Rectal sensation for distention was unchanged, and rectal electrosensitivity improved (P = 0.04). CONCLUSIONS: Rectovaginopexy provides significant one-year improvement of both constipation and fecal incontinence. The positive effect on constipation did not deteriorate with time, in contrast to the effect on fecal incontinence.
KW - Abdominal rectopexy
KW - Constipation
KW - Fecal incontinence
KW - Obstructed defecation
UR - http://www.scopus.com/inward/record.url?scp=0032895677&partnerID=8YFLogxK
U2 - 10.1007/BF02235188
DO - 10.1007/BF02235188
M3 - Article
C2 - 10211525
AN - SCOPUS:0032895677
VL - 42
SP - 82
EP - 88
JO - Diseases of the Colon and Rectum
JF - Diseases of the Colon and Rectum
SN - 0012-3706
IS - 1
ER -