Original Article

International Urogynecology Journal

, Volume 24, Issue 1, pp 81-89

First online:

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

  • Pascal MourtialonAffiliated withDepartment of Obstetrics and Gynaecology, Bocage University HospitalService de Gynecologie-Obstétrique et médecine de la reproduction humaine, Centre hospitalier universitaireCentre d’épidémiologie des populations, INSERM EA 4184, Université de BourgogneFaculté de médecine, Université de Bourgogne Email author 
  • , Vincent LetouzeyAffiliated withDepartment of Obstetrics and Gynaecology, Carémeau University Hospital
  • , Georges EglinAffiliated withDepartment of Obstetrics and Gynaecology, Champeau Private Hospital
  • , Renaud de TayracAffiliated withDepartment of Obstetrics and Gynaecology, Carémeau University Hospital
  • , French Ugytex Study Group

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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 prolapse Vaginal surgery Medium weight polypropylene mesh Quality of life Rectoanal function