THE ROLE OF APICAL SUPPORT AND RECTAL MUCOSAL PROLAPSE EXCISION IN SUCCESSFUL TREATMENT OF RECTOCELE COMBINED WITH PERINEUM DESCENDING: SHORTTERM AND FOLLOW-UP RESULTS

Pelvic descending syndrome for the first time was described by A.G.Parks in 1966. But in our days the problem of it surgical treatment is not completely solved. Large number of complications and recurrence, unsatisfactory functional results forced surgeons to develop new surgical techniques. The aim of the research was to improve the results of surgery treatment of posterior compartment of pelvic floor using abdominal sacrocolpopexy and stapled trance-anal resection (STARR). 59 patients underwent abdominal sacrocolpopexy with syntheticl mesh as apical support and in 52 patients this method was complementary with STARR. The post-operative outcomes were assessed in 6 months and in 2 years. The following diagnostic methods were used: POP-Q classification, defecography, anorectal functional tests with Polygraf ID device. The quantity of post-operative complications depended of mesh graft was few and didn't increase because of simultaneous STARR. Vaginal mesh erosion was in 2 (3.4%) patients underwent sacrocolpopexy and in 1 (1.9%) patient underwent sacrocolpopexy and simultaneous STARR, mesh contraction in 1 (1.9%) patient of the 2nd group, vaginal shrinkage in 1 (1.7%) patient of the 1st group, dispareunia de novo was noted in 3 (5.1%) patients of the 1st group and in 2 (3.8%) patients of the 2nd group (p ˃0.05). With POP-Q classification stage 0 of rectocele was achieved in 22(38.9%) patients underwent sacrocolpopexy and in 25(48.1%) patients underwent sacrocolpopexy with simultaneous STARR. In the other patients of both groups stage I was diagnosed. Defecography showed the lifting of the perineum body in all patients of two groups without significant difference, but absolute figures were closer to normal value in the group underwent combined surgery: in the rest -3.7±0.5cm and - 3.5±0.6 cm, in the straining -5.9±0.6 cm and -6.2±0.7 cm in the 1st and 2nd groups accordingly. The anatomical normalization of posterior anorectal angle measurement rentgenologically was noted in both groups and didn't differ statistically on surgery methods. Rentgenological absence of rectal mucosal prolapse has been noted in 15 (25.4%) patients of the 1st group and in 47(90.4%) patients of the 2nd group (p ˃0.05). Voiding was better in the 2nd group patients. Voiding normalization noted 12(20.3%) and 15(28.8%) patients, voiding improvement 28(47.4%) and 30(57.7%) and didn't change in 19(32.2%) and in 7(13.4%) patients of the 1st and 2nd groups accordingly (p<0.05). But in spite of these we observed the constant worsening of the results over time. Abdominal sacrocolpopexy with surgical mesh demonstrated satisfactory anatomical results with low complications rate for rectocele reconstruction in patients with perineum descending, including incontinence improvement. Together with STARR procedure they became even better as revealed good functional results in respect to voiding normalization, as rectal mucosal prolapsed is incised simultaneously, which is not corrected by sacrocolpopexy along. In the end our experience showed that abdominal sacrocolpopexy combined with STARR is a safe enough procedure. Keywords: Rectocele, perineum descending, rectal mucosal prolapse, sacrocolpopexy, stapled trance-anal resection, constipation