Vaginal Rectocele Repairs

Jennifer T. Pollak and G. Willy Davila

Rectocele repair represents one of the most commonly performed gynecologic pelvic reconstructive procedures. Both gynecologists and colorectal surgeons treat rectoceles. In fact, 100% of gynecologists surveyed manage rectoceles, whereas 68% of colorectal surgeons manage them.1-3 Gynecologic surgeons perform this operation on a frequent basis by itself or in conjunction with other reconstructive procedures. Dysfunction of the posterior compartment may be managed very differently by varying clinicians, and there is a lack of consensus with regard to the indications, surgical techniques, and outcome assessment.

The restoration of normal anatomy to the posterior vaginal wall is referred to as a posterior repair or colpor-rhaphy. Although frequently used interchangeably with the term rectocele repair, the two operations may have vastly different treatment goals. Whereas a rectocele repair focuses on repairing a herniation of the anterior rectal wall into the vaginal canal caused by a weakness in the recto-vaginal septum, a posterior colporrhaphy is designed to correct a posterior vaginal wall bulge, as well as normalize vaginal caliber by restoring structural integrity to the posterior vaginal wall and introitus.

This chapter will cover various aspects of the gynecologic approach to rectocele repair, including symptoms, anatomy, physical examination, indications for repair, surgical techniques, and treatment outcomes.

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