Colpopexie infracoccygéale translévatorienne postérieure (IVS): faisabilité et premiers résultats d'une série continue de 108 cas

[Cure of rectocele by vaginal way]

Rectocele is a rectal hernia through the posterior vaginal wall. There is three levels of rectocele. High rectocele is caused by the uterosacral and cardinal ligaments stretching; it needs prerecti fascia placation with a sacrofixation of an associated prolapsus of uterus or vaginal vault. The middle rectocele is linked with a rectovaginal fascia defect; the preferential choice for middle rectocele is midline fascial plication; superior myoraphy gives dyspareunia. The inferior rectocele results of a destruction of the perineal body; the treatment is a myoraphy with vulvoraphy. Complete rectocele would be an indication for a posterior mesh.

[What about transvaginal mesh repair of pelvic organ prolapse? Review of the literature since the HAS (French Health Authorities) report]

The French Health Authorities' (HAS) report of November 2006 concluded that the use of mesh at the time of transvaginal repair of pelvic organ prolapse (POP) should be limited to clinical research. This review intends to analyse and comment the recent data on this topic. A review on PubMed, on a personal database and actualisation until May 2008 has been performed choosing French or English language series concerning prolapse surgery with mesh disposed by the vaginal route. It includes six randomised controlled trials comparing transvaginal repair of POP with or without mesh: four about cystocele, one about rectocele and one about apical prolapse. Both surgical techniques and recurrence criteria are poorly standardised. The four randomised trials focusing on cystocele repair support the anatomical superiority of techniques using mesh, with similar functional results with or without mesh reinforcement. In the other indications, the results remain unclear or controversial. According to the randomised trials, the complications rate, except mesh exposure, is similar with and without mesh. However there are some specific complications when using mesh, such as mesh infection, mesh exposure or shrinkage and visceral extrusion. We recommend using vaginal reinforcement mesh with specific care in selected patients and we suggest some guidelines to be proposed for consensus at concerned French scientific societies.