Posterior colporrhaphy plus dermal graft eases bowel dysfunction.(Gynecology)

RANCHO MIRAGE, CALIF. -- Posterior colporrhaphy with AlloDerm graft augmentation significantly improved bowel dysfunction while causing no major complications in a prospective study of 188 women treated for symptomatic rectocele.

Symptoms of constipation, incomplete evacuation, and fecal incontinence improved significantly over a mean 18-month follow-up period. Dyspareunia rates also improved, compared with baseline, but the difference was not statistically significant, Ahsen Chaudhry, M.D., and Robert W. Lobel, M.D., both of Albany, N.Y., reported in a poster at the annual meeting of the Society of Gynecologic Surgeons.

Among the study patients, 5% developed prolapse recurrence, and 4% reported rectal pain occurring more than once per month after the surgery. Rectal pain was not assessed preoperatively so any change in pain status remains unknown.

One patient rejected a 1-by-2-cm portion of the 4-by-7-cm dermal graft and was treated with partial graft excision and topical estrogen. Another patient developed a 2-cm abscess in the posterior vaginal wall and was treated with abscess drainage and antibiotics.

"Posterior colporrhaphy with AlloDerm graft augmentation shows good safety and efficacy. Recurrence of prolapse is minimal," said Dr. Chaudhry in an oral presentation of the findings. "A randomized controlled trial would improve our knowledge of this operation."

Gynecologists use various techniques to repair symptomatic rectoceles. Conventional colporrhaphy involving midline plication of rectovaginal fascia carries significant risks for mid-vaginal stenosis and dyspareunia, he said. Aggressive levatorplasty may lead to levator spasms and dyschezia.

Success rates for conventional posterior colporrhaphy of up to 75% at 1-2 years after surgery decline significantly ...