Effectiveness of surgery for pelvic organ prolapse with rectocele formation

• Mekan R. Orazov
• Lyudmila M. Mikhaleva
• Mikhail V. Krestinin

Abstract

The aim of the study was to improve the outcomes of surgical treatment of patients with posterior vaginal wall prolapse with rectocele formation.

Material and methods. 76 patients (mean age 40.6±2.0 years) suffering from the posterior vaginal wall prolapse with rectocele formation were included in the investigation. The patients of the cohort under study were stratified into two groups depending on the method of surgical treatment. In group I (investigated) (n=38) rectocele was surgically treated with the original method (patent No 2781325 in the state register of inventions of the Russian Federation, 11.10.2022) with dual plication of Denonvilliers’ fascia and levatoroplasty. The comparison group (n=38) consisted of women who underwent standard posterior colporrhaphy with perineolevatoroplasty.

Results. Patients in the cohort under study were homogeneous according to basic anthropometric indices (BMI in the study group 25.83±2.02 versus 22.12±2.32 kg/m² in the comparison group), as well as by reproductive and somatic history (p>0.05). No statistically significant differences were found between the incidence of intra- and early postoperative complications in the women of the compared groups (p>0.05). A high incidence of dyspareunia was found in patients operated on by conventional posterior colporrhaphy with perineolevatoroplasty compared with double fascioplasty and levatoroplasty (VAS 19.24±12.72 versus 4.51±4.73, p=0.004). Frequency of vaginal wall prolapse recurrence with rectocele formation 2 years after the operation occurred significantly (p<0.001) more frequently after traditional posterior colporrhaphy with perineolevatoroplasty versus double plication of the Denonvilliers’ fascia and levatoroplasty: 28.9% versus 5.3% (p<0.001).

Conclusion. High effectiveness of the original method of surgical treatment of rectocele was established; it permits to decrease the relapse rate in 2 years after the operation by 5.5 times, the severity of dyspareunia by 2,0 times in comparison with the standard colporrhaphy and perineolevatoroplasty (p<0.05).

Design: open independent comparative prospective study.

Keywords:рelvic organ prolapse, pelvic floor muscle failure, rectocele, recurrence

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