It is difficult to determine what types of procedures should be attempted in patients who have recurrent prolapse.
We present a case of recurrent lateral enterocele and rectocele after the patient had undergone multiple surgeries for pelvic organ prolapse (POP), including a vaginal hysterectomy, bladder-neck suspension, anterior colporrhaphy, site-specific rectocele repair, apical mesh implant, iliococcygeus vault suspension, and transobturator suburethral sling procedure. With recurrence, the patient underwent robot-assisted laparoscopic sacral colpopexy, tension-free vaginal tape transobturator sling insertion, rectocele repair, and perineorrhaphy with cystoscopy. She then presented with defecatory outlet obstruction and constipation and subsequently was treated with a stapled transanal rectal resection. The patient returned with continued defecatory dysfunction and a recurrent lateral enterocele and rectocele. The recurrence was treated laparoscopically using a lightweight polypropylene mesh. The postoperative period was uneventful. Two years later, the patient reported decreased defecatory symptoms and no further symptomatic prolapse.
Written by:
Solomon ER, Muffly TM, Hull T, Paraiso MF. Are you the author?
Department of Obstetrics and Gynecology, Division of Urogynecology and Pelvic Surgery, Baystate Medical Center, 759 Chestnut Street, Springfield, MA, 01199, USA.
Reference: Int Urogynecol J. 2014 Sep 16. Epub ahead of print.
doi: 10.1007/s00192-014-2465-z
PubMed Abstract
PMID: 25224146