Late results of combined rectovaginal septum plastic surgery using a mesh in patients with low rectocele

AIM: to evaluate the functional results of combined rectovaginal septum plastic surgery using a mesh in patients with low rectocele grade 2–3 three years after surgery. PATIENTS AND METHODS: a single-center prospective observational study included 40 patients with isolated low anterior rectocele of grade 2–3 and complaints of the need for manual assistance during defecation (2012–2019). The median age was 56.5 (51; 60) years. The second degree of the disease was noted in 30/40 (75%; 95% CI: 57.3–87%), the third — in 10/40 women (25%; 95% CI: 8.1–55.8%). Preoperative defecography proved the presence of a saccular protrusion in the low third of the vagina and perineal descending syndrome in all patients, excluded signs of internal rectal intussusception and puborectal muscle spesm. In order to correct the low rectocele, transvaginal combined plastic surgery of the rectovaginal septum was performed using a mesh implant protected from contact with the vaginal mucosa by sutured levators. To assess the functional results of the surgery, the Cleveland Constipation Scale (Wexner), the SF-36 questionnaire, and the "Questionnaire for Assessing the Quality of Life in Rectal Surgeries" were used before and 3 years after the surgery. RESULTS: three years after surgery, the low rectocele recurrence developed in 2/40 (5.0%; 95% CI: 1.4–16.5%) patients, while none complained of the need for manual assistance when emptying the rectum. Rectocele was not detected in 38/40 (95%) women (p < 0.001) by defecography, while in 2 patients with recurrence, the rectocele depth was 20 mm and 22 mm, and the position of the anorectal zone in straining decreased from 30 (30; 34.8) mm to 20 (10; 30) mm (p < 0.001). The intensity of bowel movement disorders according to the Cleveland Constipation Scale (Wexner's) decreased from 10 (7; 13) points to 5.5 (3; 7) (p < 0.001). After 3 years, an increase was noted in both the indicators of the physical and psychological health components of the SF-36 questionnaire to 47.9 (42.4; 52.7) and 53.2 (44.8; 58) points, respectively (p < 0.001), as well as all 8 scales of the “Questionnaire for Assessing the Quality of Life in Rectal Surgeries” (p < 0.001). CONCLUSION: combined plastic surgery of the rectovaginal septum with a mesh implant protected from contact with the vaginal mucosa by sutured levator muscles for low rectocele grades 2-3 only, leads to the elimination of manual assistance need in defecation, a decrease in the severity of constipation, and an improvement in the quality of life.