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. 2010 Jun;21(6):623-30.
doi: 10.1007/s00192-010-1097-1. Epub 2010 Feb 10.

Midline fascial plication under continuous digital transrectal control: which factors determine anatomic outcome?

Alfredo L Milani  1 , Mariella I J Withagen, Karlijn J Schweitzer, Erica W M Janszen, Mark E Vierhout
Affiliations

Midline fascial plication under continuous digital transrectal control: which factors determine anatomic outcome?

Alfredo L Milani et al. Int Urogynecol J. 2010 Jun.

Abstract

Introduction and hypothesis: The aim of the study was to report anatomic and functional outcome of midline fascial plication under continuous digital transrectal control and to identify predictors of anatomic failure.

Methods: Prospective observational cohort. Anatomic success defined as POP-Q stage <or= I of the posterior compartment. Validated questionnaires to measure bother and impact on quality of life. Logistic regression to identify risk factors for anatomic failure.

Results: Two hundred thirty-three patients with posterior pelvic organ prolapse (POP) stage >or= II underwent midline fascial plication under continuous digital transrectal control. Median follow-up was 14 months (12-35 months), and anatomic success was 80.3% (95% CI 75-86). Independent predictors of failure were posterior compartment POP stage >or= III [OR 8.7 (95% CI 2.7-28.1)] and prior colposuspension [OR 5.6 (95% CI 1.1-27.8)]. Sixty-three percent of patients bothered by obstructed defaecation experienced relief after surgery.

Conclusions: Anatomic and functional outcomes were good. Risk factors for anatomic failure were initial size of posterior POP (stage >or= III) and prior colposuspension.

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Figures

Fig. 1
Fig. 1
Modified midline fascial plication of stage II posterior vaginal wall prolapse. a Incision after hydrodissection. b Sideward traction and cleaving of vaginal wall. c Blunt dissection of fascia. d Suturing at cranial side of rectocele. e Tie of a knot by the assistant of the surgeon. f Rectal control of firmness. g Trimming of vaginal wall. h End result after running suture of vaginal wall
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