Laparoscopic Mesh Sacropexy for Voluminous Rectocele.

The rectocele represents a protrusion of the rectum through the rectovaginal fascia, which appears as a bulge in the posterior vaginal wall. Surgical treatment includes many procedures which can be performed by four types of approaches: transvaginal, transanal, transperineal and transabdominal.Voluminous rectocele cases are rare and often represent a surgical challenge. Only two types of approaches are proved to be feasible for the treatment of a voluminous rectocele, the transvaginal and the transabdominal approaches. To resolve these cases, the authors propose laparoscopic mesh sacropexy.The procedure implies retrorectal dissection and rectovaginal dissection down to the pelvic floor, followed by a rectovaginopexy to the sacral promontory, using an y-shaped polypropylene mesh. One arm of the mesh is fixed to the anterior rectal wall using four stitches and the other arm is sutured to the posterior vaginal wall. The end of the mesh is fixed to the promontory. Thus, the anchoring of the prolapsed rectum and the posterior vaginal fornix to the sacral ligamentis achieved, the damaged rectovaginal fascia being substituted by the polypropylene mesh. The main symptom that was tracked, difficulty in defecation, was significantly improved, none of the patients needed any longer digital maneuvers to empty the rectum. The good results of the first experience make us believe that this procedure is an attractive solution to resolve these difficult cases.