International Urogynecology Journal

, Volume 24, Issue 1, pp 81–89

Transischioanal trans-sacrospinous ligament rectocele repair with polypropylene mesh: a prospective study with assessment of rectoanal function

  • Pascal Mourtialon
  • Vincent Letouzey
  • Georges Eglin
  • Renaud de Tayrac
  • French Ugytex Study Group
Original Article

DOI: 10.1007/s00192-012-1813-0

Cite this article as:
Mourtialon, P., Letouzey, V., Eglin, G. et al. Int Urogynecol J (2013) 24: 81. doi:10.1007/s00192-012-1813-0
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Abstract

Introduction and hypothesis

Despite good anatomical outcomes of pelvic organ prolapse (POP) repair by the vaginal route using synthetic mesh, complications limit their use. Clinical data are needed to generalize prolapse mesh repair by the vaginal route. The current study aims to evaluate midterm rectoanal function and clinical outcomes after transischioanal rectocele repair using a medium weight polypropylene mesh.

Methods

Between March 2003 and June 2004, 230 patients with stage II–IV anterior and/or posterior POP were included in a prospective multicenter study. The current study is based on the analysis of the 116 patients who underwent a rectocele repair via the infracoccygeal route through the sacrospinous ligament. Anatomical cure was defined when rectocele was at stage <II in the Pelvic Organ Prolapse Quantification (POP-Q) system. Postoperative functional results were evaluated using the self-administered Pelvic Floor Distress Inventory (PFDI) and the Pelvic Floor Impact Questionnaire (PFIQ).

Results

Of the 116 patients who received a posterior mesh with two arms via the infracoccygeal route through the sacrospinous ligament, midterm anatomical results were available for 78 women representing 67 % (78/116) of the operated patients. The mean follow-up was 36 (± 8.1) months. No rectal injury occurred during surgery. The objective success rate was 94.8 % and subjective (by patient satisfaction) was 93.23 %. Colorectal-Anal Impact (CRAI) and Colorectal-Anal Distress Inventory (CRADI) scores were both significantly decreased at midterm follow-up in comparison with baseline (42.7 at baseline vs 11.4 at 24- or 36-month follow-up, p = 0.001 for CRAI, and 81.1 vs 34.4, p < 0.001 for CRADI) highlighting the benefits of rectocele repair on colorectal-anal function.

Conclusions

Polypropylene mesh with two arms via the infracoccygeal route through the sacrospinous ligament has good anatomical results at midterm follow-up with significant improvement in symptoms and quality of life and is associated with few complications. Obstructive symptoms reported in cases of rectocele can be improved by transvaginal mesh repair.

Keywords

Genital prolapseVaginal surgeryMedium weight polypropylene meshQuality of lifeRectoanal function

Abbreviations

POP

Pelvic organ prolapse

POP-Q

Pelvic Organ Prolapse Quantification system

ICS

International Continence Society

PFIQ

Pelvic Floor Impact Questionnaire

PFDI

Pelvic Floor Distress Inventory

CRAIQ

Colorectal-Anal Impact Questionnaire

CRADI

Colorectal-Anal Distress Inventory

Copyright information

© The International Urogynecological Association 2012

Authors and Affiliations

  • Pascal Mourtialon
    • 1
    • 4
    • 5
    • 6
  • Vincent Letouzey
    • 2
  • Georges Eglin
    • 3
  • Renaud de Tayrac
    • 2
  • French Ugytex Study Group
  1. 1.Department of Obstetrics and GynaecologyBocage University HospitalDijonFrance
  2. 2.Department of Obstetrics and GynaecologyCarémeau University HospitalNîmesFrance
  3. 3.Department of Obstetrics and GynaecologyChampeau Private HospitalBéziersFrance
  4. 4.Service de Gynecologie-Obstétrique et médecine de la reproduction humaineCentre hospitalier universitaireDijon CedexFrance
  5. 5.Centre d’épidémiologie des populationsINSERM EA 4184, Université de BourgogneDijonFrance
  6. 6.Faculté de médecine, Université de BourgogneDijonFrance