Results of clinical application Apogee (Apogee AMS USA) for surgical correction rectocele

Frequency of occurrence rectocele is 5.7% for women in perimenopause. The main method of treatment rectocele is surgical. The high recurrence rates (19–43% according to A.B. Smirnova et al. 2006), poor functional outcome since 1955 led. to the beginning of a rectocele surgery of synthetic materials for the further strengthening of pelvic floor.

The purpose of the study was to determine the effectiveness of the transgluteal system Apogee (Apogee AMS, USA) in the surgical treatment of posterior and/or apical prolapse, including posthysterectomy prolapse (PHP) with high level of rectocele.

The research involved 65 patients suffering from posterior and apical, and PHP of pelvic organs with a predominance of rectocele 2–4 stage. All patients were performed reconstructive plastic surgery for the correction of pelvic floor defects, in isolation and in combination with correction of the anterior pelvic floor in the period from September 2008. to March 2011. The average age of patients was 55 years (28 to 72 years). On the severity of rectocele (classification POP-Q, ICS, 1996): II stage was diagnosed in 28 (40.1%), III stage – in 33 (50.8%), IV – in 4 (6.2%). For an objective evaluation of syndrome in patients with completed questionnaires using a scale S. Wexner (1996). Made dynamic defecoproctography, pelvic dynamic ultrasound and pelvic floor. The main operational manual was back colporrhaphy installing access systems Apogee, perineolevatoroplastic. This surgery was performed in isolation and combined with a sling operations for anterior prolapse and stress urinary incontinence. Intraoperatively confirmed the presence of defects rectovaginal septum, expansion translevator space. Intraoperative complications were not. Follow-up period was 2.5 years. During follow-up did not reveal a single case of disease recurrence. One (1.5%) patient after 2 months from the time of surgery marked the difficulty and pain during defecation in the control examination. Later, after six months of such complaints the patient has not expressed. All patients noted normalization of defecation and sexual function. Cases of implant failure in our study was not observed.

Thus, the results of our study confirm the high degree of efficiency and expediency of system Apogee in the surgical correction of the rectocele in primary and PHP of the pelvic organs. The absence of intraoperative and early postoperative complications, satisfactory functional results characterize the system Apogee as effective treatment for posterior and apical, including posthysterectomy prolapse of varying severity.

Summary:

Examined and surgical treatment of 65 patients suffering from rectocele and rectocele PHP dominated by installing system Apogee in combination with perineolevatoroplastic. Intra- and early postoperative complications, recurrence disease over the observation period were observed.