REPAIR OF POSTERIOR VAGINAL WALL DEFECTS WITH PELVICOL™ IMPLANT ANCHORED TO ILIOCOCCYGEUS

Submitted: 18 June 2010
Accepted: 18 June 2010
Published: 1 July 2010
Abstract Views: 469
PDF: 471
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Pelvic floor prolapse is a frequent condition in the female population, inevitably deemed to increase with the population average age increase. If quality of life of women suffering from pelvic prolapse is investigated, the impact of symptoms may result dramatic, causing psychological, relational, sexual, working problems. Posterior vaginal wall defects are classified as rectocele and enterocele. Rectocele means hernia or protrusion of the anterior wall of rectum in vagina, such condition being determined both by softening of posterior vaginal wall and by damaging of lateral insertions of the vagina to the pelvic wall. RIASSUNTO Il descensus del pavimento pelvico è una condizione frequente nella popolazione femminile, destinata inevitabilmente ad aumentare con l’aumento dell’età media della popolazione. Se si indaga sulla qualità della vita delle donne affette da descensus pelvico, risulta che l’impatto dei sintomi può essere drammatico, creando problemi psicologici, relazionali, sessuali ed occupazionali. I difetti della parete vaginale posteriore vengono classificati come rettocele ed enterocele. Per rettocele s’intende l’ernia o protrusione della parete anteriore del retto in vagina, tale condizione può essere determinata sia da un’attenuazione della paAim of the study is to use a surgical technique for the treatment of posterior vaginal wall defects and a type of prosthetic material that solves the pathology, being in the meanwhile the least invasive as possible, not having high costs and not leaving physical and/or psychological invalidating problems. In the choice of the type of surgical intervention to be carried out for the correction of an anatomical and/or functional defect is necessary to carefully evaluate the impact that this intervention may cause to women’s life and - as the evidencebased medicine imposes - it is necessary to evaluate the adequacy of medical interventions as to the possibility that they offer to promote or regain health. The surgical technique used foresees a transversal incision of the posterior vaginal wall at the rima vulvae with detachment of the vagina and exposure of the rectovaginal septum up to the posterior fornixes. Exposing the ischial spine, a Vicryl point is given bilaterally 1 cm forward and upward to the spine itself. Thus the PelvocolTM tape is fixed with the same thread that consequently anchors the wall of the vaginal fundus, De Lancey II-III point. With this technique the musculi levatoris ani are not medialized, there are no sutures in the vagina, thus guaranteeing a normal anatomy and a normal vaginal axis, avoiding the onset of dyspareunia and pain in the sacral region, as a consequence of the traditional posterior colporrhaphy or the suspension correction to the ligamentum sacrospinalis. rete vaginale posteriore che da un danneggiamento delle inserzioni laterali della vagina alla parete pelvica. Scopo dello studio è quello di utilizzare per la cura dei difetti della parete vaginale posteriore, una tecnica chirurgica e un tipo di materiale protesico che al contempo risolva la patologia, sia il meno possibile invasivo, non abbia costi elevati e non lasci esiti invalidanti fisici e/o psichici. Nella scelta del tipo d’intervento chirurgico da effettuare per la correzione di un difetto anatomico e/o funzionale è necessario valutare attentamente l’impatto che tale intervento può avere sulla vita della donna e come c’impone la medicina basata sull’evidenza, è necessario valutare l’appropriatezza degli interventi medici in relazione alla possibilità che offrono di promuovere o recuperare il bene salute. La tecnica chirurgica utilizzata prevede un’incisione trasversale della parete vaginale posteriore a livello della rima vulvare con scollamento della vagina ed evidenziazione del setto rettovaginale fino ai fornici posteriori. Repertando la spina ischiatica, si appone un punto di vicryl bilateralmente ad 1 cm in avanti ed in alto alla spina stessa. La bendarella di Pelvicol ™ viene così fissata con lo stesso filo che conseguentemente ancora la parete del fondo vaginale, II-III punto di De Lancey. Con tale tecnica i muscoli elevatori dell’ano non vengono medializzati, non vi sono suture in vagina il chè garantisce una normale anatomia ed un normale asse vaginale evitando l’insorgenza di dispareunia e dolore in regione sacrale, quale conseguenza della tradizionale col- 14 UROGYNAECOLOGIA INTERNATIONAL JOURNAL P. LIGUORI, R. RIPOLI The utilized material is Pelvicol, a sterile, biocompatible fabric, made up of acellular collagen matrix and elastin fibres, derived from pig dermis. The correction of grade I, II and III rectocele has been rarely applied in the past due to the concern of creating an excessive reduction in the vaginal caliber with complications such as reduced vaginal capacity and dyspareunia. Our experience demonstrated that the carrying out of the above described surgical technique not only guarantees the anatomical preservation of the posterior segment, but represents an optimal repair of the pelvic statical defect. The Pelvicol implant guarantees to women the return to normal social and sexual life, so that this method is to be privileged with respect to traditional surgical techniques. However, this surgery needs a wider usage trial by other surgeons, in order to find its definite role in rectocele surgical therapy.

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Liguori, P., & Ripoli, R. (2010). REPAIR OF POSTERIOR VAGINAL WALL DEFECTS WITH PELVICOL™ IMPLANT ANCHORED TO ILIOCOCCYGEUS. Urogynaecologia, 20(1), 13–29. https://doi.org/10.4081/uij.2006.1.13

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