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Approche chirurgicale vaginale et/ou périnéovaginale des rectocèles

The vaginal and/or vaginoperineal approach to rectocele corrective surgery

  • Dossier Thématique / Thematic File
  • Published:
Côlon & Rectum

Résumé

Le traitement de la rectocèle par voie transpérinéovaginale fait appel à des techniques traditionnelles comme la colpopérinéorraphie postérieure avec ou sans myorraphie des releveurs, la plicature médiane du fascia rectovaginal ou la réparation site specific ou à l’interposition entre le rectum et le mur vaginal postérieur d’un implant prothétique biologique ou synthétique. En raison d’un taux de dyspareunie postopératoire préoccupant, la classique myorraphie a été progressivement délaissée au cours des dix dernières années au profit de la plicature fasciale ou de la réparation site specific à la carte. Néanmoins dans le but de réduire le risque de récidive, des réparations prothétiques ont été suggérées faisant appel soit à du matériel biologique, soit à du matériel synthétique, résorbable ou non. Les résultats avec les implants biologiques ont été décevants avec des taux inacceptables de récidives. Les premiers résultats avec l’utilisation de prothèses synthétiques sont prometteurs, mais des interrogations persistent face à des complications spécifiques comme la rétraction ou l’exposition de matériel et le risque de dyspareunie de novo. Cette chirurgie doit donc actuellement être réservée aux patientes avec récidive ou prolapsus de haut grade ou à des patientes loyalement informées incluses dans des études prospectives randomisées.

Abstract

Rectocele repair via a transvaginal approach involves such traditional procedures as posterior colporraphy with or without myorraphy, midline fascial plication and site specific repair, or mesh repair with biological or synthetic implant. Because of an increased risk of postoperative dyspareunia, surgeons are reluctant to perform levator myorraphy, resulting in midline fascial plication and site specific repair having gained general acceptance over the last decade. Nevertheless, in an attempt to reduce recurrence, mesh repair using biological or synthetic (absorbable or non absorbable) implants has been suggested. First results with synthetic implants are promising but important issues such as mesh shrinkage, mesh extrusion or de novo dyspareunia have to be addressed. Currently, therefore, the use of mesh has to be restricted to patients with recurrence and stage 3 or 4 pelvic organ prolapse or to informed and consenting patients enrolled in prospective randomized trials.

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  1. Unité d’urogynécologie, maternité Hôtel-Dieu, boulevard Léon Malfreyt, F-63058, Clermont-Ferrand Cedex 1, France

    B. Fatton

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Fatton, B. Approche chirurgicale vaginale et/ou périnéovaginale des rectocèles. Colon Rectum 2, 71–81 (2008). https://doi.org/10.1007/s11725-008-0086-8

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  • DOI: https://doi.org/10.1007/s11725-008-0086-8

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