Outcome after rectovaginal fascia reattachment for rectocele repair

Objective: This study was undertaken to determine the effects of rectovaginal fascia reattachment on symptoms and vaginal topography. Study Design: Standardized preoperative and postoperative assessments of vaginal topography (the Pelvic Organ Prolapse staging system of the International Continence Society, American Urogynecologic Society, and Society of Gynecologic Surgeons) and 5 symptoms commonly attributed to rectocele were used to evaluate 66 women who underwent rectovaginal fascia reattachment for rectocele repair. All patients had abnormal fluoroscopic results with objective rectocele formation. Results: Seventy percent (n = 46) of the women were objectively assessed at 1 year. Preoperative symptoms included the following: protrusion, 85% (n = 39); difficult defecation, 52% (n = 24); constipation, 46% (n = 21); dyspareunia, 26% (n = 12); and manual evacuation, 24% (n = 11). Posterior vaginal topography was considered abnormal in all patients with a mean Ap point (a point located in the midline of the posterior vaginal wall 3 cm proximal to the hymen) value of –0.5 cm (range, –2 to 3 cm). Postoperative symptom resolution was as follows: protrusion, 90% (35/39; P< .0005); difficult defecation, 54% (14/24; P< .0005); constipation, 43% (9/21; P = .02); dyspareunia, 92% (11/12; P = .01); and manual evacuation, 36% (4/11; P = .125). Vaginal topography at 1 year was improved, with a mean Ap point value of –2 cm (range, –3 to 2 cm). Conclusion: This technique of rectocele repair improves vaginal topography and alleviates 3 symptoms commonly attributed to rectoceles. It is relatively ineffective for relief of manual evacuation, and constipation is variably decreased. (Am J Obstet Gynecol 1999;181:1360-4.)