Modifications of the Rectocele Repair

The posterior colporrhaphy and the discrete fascial defect repair may be combined. After dissecting the rectovaginal fascia off the overlying vaginal mucosa, all fascial tears are identified and the edges are reapproximated with permanent suture, such as silk. The levator ani muscles can then be plicated in the midline, anterior to the rectovaginal fascia, using absorbable suture in the traditional manner.

Reconstructive pelvic surgeons have reported reinforcement of prolapse repairs with synthetic and biologic pros-theses. Synthetic mesh is widely used for anti-incontinence surgery and abdominal sacrocolpopexy to repair vaginal vault prolapse. Although high success rates have been reported, erosion of the mesh and infection have been associated with these repairs.8,9 Autologous grafts and allograft prostheses, including fascia lata, rectus sheath, and dermal grafts have been used for these surgeries as well as reinforcement of repairs to reduce these complications. Few complications have been associated with these grafts, and they have a comparable success rate to synthetic materials. Xenograft material, including bovine pericardium and porcine skin and small intestinal mucosa, had also been used to reinforce these repairs; however, no reports on complications and success rates exist in the literature.

When using graft material to reinforce a rectocele repair, the graft may be sutured to the lateral posterior vaginal sulcus on each side using absorbable or permanent suture. The graft should be trimmed before placement so that it lies as a flat layer between the vaginal mucosa and the newly repaired rectovaginal fascia (Figure 8-5.5). There is no evidence that soaking the graft material in antibiotic solution before placement decreases the incidence of vaginal infection or erosion.

Few studies have reported on the use of graft materials to reinforce posterior compartment defects. Sand et al.10 reported on 132 women undergoing either standard rectocele repairs or rectocele repairs reinforced with polyglactin 910 mesh (an absorbable mesh), and found no difference in recurrence rates between the two groups. Two small observational studies on the use of Marlex mesh for rectocele repair did not report erosion or recurrence.11,12

Bacterial Vaginosis Facts

Bacterial Vaginosis Facts

This fact sheet is designed to provide you with information on Bacterial Vaginosis. Bacterial vaginosis is an abnormal vaginal condition that is characterized by vaginal discharge and results from an overgrowth of atypical bacteria in the vagina.

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