Discrete tears or breaks in the rectovaginal fascia or rectovaginal septum have been described and may contribute to the formation of rectoceles (Figure 8-5.2). Similarly to hernia repairs performed by general surgeons, the technique involves identifying the discrete fascial tears, reducing the hernia, and then closing the defect. The surgical dissection is similar to the traditional posterior colporrha-phy whereby the vaginal mucosa is dissected off the underlying rectovaginal fascia to the lateral border of the levator muscles. This dissection must be done very carefully to avoid creating iatrogenic fascial defects. Instead of plicat-ing the fascia and levator muscles in the midline, however, the fascial tears are identified, and the edges are reapprox-imated with interrupted permanent sutures. Richardson6 describes pushing anteriorly with a finger in the rectum to identify areas of rectal muscularis that are not covered by the rectovaginal septum. Thereby, the operator can locate fascial defects, identify fascial margins, and reapproximate them. A perineoplasty may be necessary if a widened vaginal hiatus is present. The discrete fascial defect repair may also be used to correct enteroceles by attaching torn endopelvic fascia to its apical attachment site at the cervix or cardinal-uterosacral ligament complex with interrupted sutures.
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