Surgery to Correct a Rectocele

There are several goals of surgery to repair a rectocele. Endopelvic fascial integrity from the apex to the perineum and levator plate integrity should be reestablished. The anterior rectal wall should be well supported. The perineal body needs to be reinforced. The end result should be a vagina with normal caliber and length.

Figure 8-5.4. Multiple interrupted sutures are used to approximate the endopelvic fascia at the perineal body apex in the midline.

ineum and widened genital hiatus. Preoperatively, the severity of the rectocele is assessed, as well as the desired final vaginal caliber. Allis clamps are placed on the inner labia minora/hymen remnants bilaterally and then approximated in the midline. The resultant vagina should loosely admit two to three fingers. A triangular incision over the perineal body is made between the Allis clamps, and sharp dissection is then performed to separate the posterior vagina from the underlying rectovaginal fascia. A midline incision is made along the length of the vagina to a site above the superior edge of the rectocele.

The dissection is carried laterally to the lateral vaginal sulcus and medial margins of the puborectalis muscles. The rectovaginal fascia with or without the underlying levator ani muscles is then plicated with interrupted sutures beginning at the level of the levator plate, while depressing the anterior rectal wall with the nondominant hand (Figure 8-5.4). Typically, thick, absorbable sutures using No. 1 Vicryl are placed along the length of the rectocele until plication to the level of the perineal body is complete. Excess vaginal mucosa is carefully trimmed and then reapproximated. A concomitant perineoplasty may be performed by plicating the bulbocavernosus and transverse perineal muscles in the midline with No. 1 Vicryl. This reinforces the perineal body and provides enhanced support to the corrected rectocele.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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