Rectal or Intestinal Prolapse or Bulge into Vagina (Rectocele/Enterocele Repair or Posterior Repair)
A Rectocele is when the rectum prolapses into the vagina and may become a visible or palpable bulge. This condition may cause pelvic pressure, difficulty emptying the rectum, a vaginal bulge that can be felt, and constipation . Some patient will need to place a finger in the vagina, called splinting, to assist in emptying the rectum. Repair of Rectocele involves the surgical reduction of the bulge and placing the rectum back into its normal anatomic location. As with other forms of pelvic organ prolapse (cystoceles, enteroceles, vaginal prolapse) childbirth, chronic cough, chronic constipation, and obesity are predisposing factors.
The traditional repair for a Rectocele is plicating or overlapping tissues with suture to reduce the bulge and support the rectum. Excess vaginal tissue is also usually trimmed at the time of surgery. Medically this is called an Posterior Repair or Posterior Colporrhaphy. This repair however does not address defects that occur higher in the vagina and therefore may fail with return of symptoms.
Modern repair have attempted to uses absorbable grafts or non absorbable mesh in an effort to prevent recurrence of the Rectocele. The placement of these materials in a safe and effective manner is highly dependent on the surgeon’s skill and experience. Having used these method extensively over the past number of years, my experience has been a success rates of about 90% in my hands.
The use of the da Vinci Robotic Surgical System has allowed Dr. Mathews to expand the application of the Sacrocolpopexy technique to address patients with Rectoceles. No longer is it necessary to perform both a robotic assisted abdominal procedure and a vaginal procedure in patients with prolapse of the vagina and rectum. This minimally invasive technique results in quicker recovery and return to normal activity.