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Abstract
A rectocele, or posterior vaginal wall prolase, is thought to be a herniation of the anterior rectal and posterior vaginal wall into the lumen of the vagina, which arises from either a tear or an attenuation of the rectovaginal (Denonvilliers’) fascia. Mild rectocels may be asymptomatic, however, larger ones can cause symptoms of a bearing-down sensation, pelvic heaviness, incomplete bowel emptying even necessitating splinting or manual evacuation (Paraiso, 2001 and Weber, 2000).
The last decade has shown significant advances in the treatment of rectocele. In standard, rectocele has been treated with posterior colporrhaphy, which consist of a midline plaication of the recto-vaginal fascia through a transvaginal approach. This approach has a limited application for several reasons. First, it assumes that the anatomic defect is due to a general stretching or weakening of the rectovaginal fascia, and that midline plaication will strengthen this layer. Second it depends on adequate strength of the rectovaginal septum for long term support. Reported success rates with the traditional midline repair range from 65-75% in one year follow-up (Kohli and Miklos, 2003).