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Related Disorders
Published in Han C. Kuijpers, Colorectal Physiology: Fecal Incontinence, 2019
Robert D. Madoff, Stanley M. Goldberg
It is useful when planning treatment to classify rectovaginal fistulas into two categories: simple and complex.1,2,7 Simple fistulas are less than 2.5 cm in diameter, occur in the low to mid-rectovaginal septum, and are caused by trauma (including iatrogenic and obstetric) or infection. Complex fistulas are greater than 2.5 cm in diameter, occur in the high rectovaginal septum, are caused by inflammatory bowel disease, radiation therapy or neoplasm, or are previously “simple” fistulas that have failed multiple previous repairs.
Rectal Prolapse and Associated Pelvic Organ Prolapse Syndromes
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
André D’Hoore, Oliver M. Jones
A rectocele is a bulge that occurs in the front wall of the rectum and pushes into the vagina. It occurs due to injury, weakness or laxity of the rectovaginal septum. Rectocele is covered in more detail in the Gynaecology for the Colorectal Surgeon section (Chapter 1).
Gynaecological history, examination and investigations
Published in Helen Bickerstaff, Louise C Kenny, Gynaecology, 2017
In some situations, a rectal examination with specific additional consent can be useful in addition to a vaginal examination to differentiate between an enterocele and a rectocele or to palpate the uterosacral ligaments more thoroughly. Occasionally, a rectovaginal examination (index finger in the vagina and middle finger in the rectum) may be useful to identify a lesion in the rectovaginal septum.
The use of 3D ultrasound in comparing surgical techniques for posterior wall prolapse repair: a pilot randomised controlled trial
Published in Journal of Obstetrics and Gynaecology, 2021
Alexandros Derpapas, Gopalan Vijaya, Kostis Nikolopoulos, Manolis Nikolopoulos, Dudley Robinson, Ruwan Fernando, Vik Khullar
To our knowledge, 3D translabial pelvic floor ultrasound has not been used before to compare the anatomical outcomes between different techniques for posterior wall prolapse repair. 3D US of the posterior vaginal wall does not seem to reproducibly depict discrete defects of the rectovaginal septum that are associated with rectocele formation (Dietz 2011). Hence, our efforts focussed on depicting the postoperative reduction in the urogenital and levator hiatal dimensions measured by 3D ultrasound as a means to assess the surgical outcome of posterior repair. The reasoning for selecting such ultrasound markers is based on previous evidence showing that not only is LH overdistension strongly associated with clinically evident prolapse and recurrence, but also on data suggesting that clinically measured enlarged urogenital hiatus is persistent in women with failed surgical repairs (Delancey and Hurd 1998; Barry et al. 2006; Model et al. 2010; Dietz et al. 2011).
Which factors are associated with the recurrence of endometrioma after cystectomy?
Published in Journal of Obstetrics and Gynaecology, 2018
Mehmet Küçükbaş, Meryem Kurek Eken, Gülşah İlhan, Taylan Şenol, Dilşad Herkiloğlu, Bilge Kapudere
No correlation was found between the extent of disease and pelvic pain in previous studies (Fedele et al. 1992; Gruppo Italiano per lo Studio dell’Endometriosi 2001). But it should be noted that dyspareunia and chronic pelvic pain are typically associated with deep infiltrating endometriosis, which is also related to the presence and extent of pelvic adhesions (Porpora et al. 2010). These symptoms are often seen when the posterior cul-de-sac and rectovaginal septum are infiltrated (Chapron et al. 2005). Vignali et al. (2005) showed higher recurrence rates in patients with deep infiltrating endometriosis. Advanced stage of endometriosis and both advanced stage and deep infiltrating endometriosis are claimed to be risk factors for recurrence (Parazzini et al. 2005; Busacca et al. 2006). Non-cyclic pelvic pain may be an indirect sign of widespread disease and extent of pelvic adhesions. In our study, patients with preoperative dysmenorrhoea and non-cyclic pelvic pain had higher rates of recurrence. We also found a higher rate of recurrence in patients who had extensive pelvic adhesion. In a previous study, they concluded there was a higher rate of recurrence in patients with extensive pelvic adhesions. It may be that indirect signs of more aggressive disease and adhesion formation cause small endometriotic lesions to be overlooked and lead to incomplete surgery (Busacca et al. 1999; Porpora et al. 2010).
Hysteropexy with single-incision vaginal support system associated with a modified culdoplasty for enterocele prevention
Published in Journal of Obstetrics and Gynaecology, 2020
Giuseppe Ettore, Gabriella Torrisi, Carla Ettore, Vincenzo Guardabasso
The surgical procedure involved the single-incision mesh kit plus a modified culdoplasty. The Uphold™ LITE Vaginal Support System (Boston Scientific Co., Marlborough, MA, USA) utilises a lightweight mesh, made from uncoated monofilament macroporous polypropylene. This is designed to provide level I support at the vaginal apex, at the same time providing level II support where a concomitant cystocele is likely to occur. The Capio® Suture Capturing Device was used to connect the mesh to the sacrospinous ligaments and suspend the apex. The surgical steps of the modified culdoplasty (Figure 2) were: (a) transverse posterior 2 cm colpotomy at the cervico-vaginal junction; (b) opening of the Douglas pouch; (c) locating the utero-sacral ligaments; (d) preparation of the rectovaginal septum; (e) transfiction of the uterosacral ligaments with a ‘U-shaped stitch’ tailoring two hemisutures which close the Douglas pouch. PDS® II 0 sutures were used (Ethicon, Bridgewater, NJ, USA). The ‘U-shaped stitch’, which was passed bilaterally, in sequence trans-fixed the upper margin of a transverse posterior colpotomy, the peritoneum, the utero-sacral ligament (at the level where the ligament converges in the uterine torus). Leaving the peritoneal cavity, it transfixed the rectovaginal fascia, the posterior vaginal wall and, retracing the same path in reverse, the vaginal wall, the rectovaginal fascia, the peritoneum, the utero-sacral ligament, exiting at the upper margin of the colpotomy, next to the entry point. The transverse posterior colporrhaphy and perineal body reconstruction were the conclusive step of the tri-compartmental repair.