Rectocele: A rectocele is the result of a defect in the recto-vaginal septum (a tough fibrous layer), which separates the vagina (anteriorly) from the rectum (posteriorly). This defect results in the protrusion of the rectum into the vagina and the resultant symptoms.
The primary indication for repair of a rectocele is obstructive defecation (inability to pass stools).
Other indications include a subjective sensation of “pressure” in the vagina and a feeling of incomplete bowel emptying. This may progress to difficult or painful defecation or sexual intercourse, constipation, incontinence, vaginal bleeding, and even prolapse of the bulge through the opening of the vagina.
Laparoscopic Ventral Mesh Rectopexy:
The operation is performed using laparoscopic/ “key-hole” surgery and it involves a small cut just below the belly button and two other small cuts on the right side of the tummy. It is performed under general anaesthetic. It is an operation to straighten and attach the rectum back into its normal position within the pelvis. The rectum is kept in this position using mesh. The surgeon frees the rectum from the pelvis and operates in front of the rectum, away from nerves supplying the bowel and genitalia. The mesh is stitched to the front of the rectum and this mesh is in turn secured to the sacrum. The effect of this is to pull the bowel up out of the pelvis and prevent it from telescoping down, restoring it to its normal anatomical position.
- Laparoscopic ventral mesh rectopexy is usually felt to be seen as “low risk surgery” because no bowel is removed.
- An additional benefit of ventral rectopexy is that the nerves that supply the bowel, bladder and sexual function are avoided. As a result, constipation which can be a problem with conventional rectopexy, only very rarely gets worse after LVMR.
- Many patients with pre-existing constipation report that this improves after ventral rectopexy. Unfortunately, some patients with obstructed defecation syndrome (ODS) and faecal incontinence do not seem to get any benefit from surgery. However, their symptoms are only rarely worse after rectopexy.
- There are small risks of other problems incl. bleeding, infection, hernia or bulge at one of the wounds or a problem with the mesh entering/piercing the bowel/ vagina. This can happen months or even years after surgery and might require further surgery to fix.
After your consultation:
- Obtain authorization from your medical aid and book your bed for your hospital admission.
- Carefully read through pre-operative information provided.
Day before surgery:
- Do not eat/drink after 22h00, the night before your surgery, unless otherwise specified by your surgeon or anaesthetist (you should be fasting for at least 6 hours before the procedure for solids but you are allowed to take clear liquids up to two hours before your procedure).
Day of surgery:
- Arrive for admission at indicated time on ‘Code & Consent’ sheet.
- Change into theatre attire, remove all valuable belongings.
Approximately 60-90 minutes.
Duration of hospital stay:
- 3-5 days (dependent on pain management, general state of patient and first bowel movement).
- Refrain from strenuous activities (incl. exercise) for at least 4 weeks post-operatively.
Back to work:
- Sick leave required post-operatively is approximately 10-14 days.
Some pain and discomfort post operatively may be expected following any operation, but the following measures are used to lessen the pain experienced:
- Warming devises in theatre as well as warm intravenous fluids.
- Intra-operative pain medication through the drip.
- Post-operative medication through the drip, please inform the nurses if you are in pain so that medication will be administered to you.
- As close to one week after discharge as possible. Please contact the rooms to schedule an appointment.