Author(s):  V.F. Kulikovsky, Dr., Prof., Belgorod National Research University, Belgorod, Russia

N.V. Oleynik, Dr., associate Professor, Belgorod National Research University, Belgorod, Russia,

A.M. Abulatifa, Belgorod National Research University, Belgorod, Russia

A.P. Krinchikova, Belgorod National Research University, Belgorod, Russia

M.S. Alenicheva, Belgorod National Research University, Belgorod, Russia

N.N. Bratisheva, Belgorod National Research University, Belgorod, Russia

Issue:  Volume 42, № 1

Rubric:  Surgery

Annotation:  The problem of perineum descending in women is still actual because of high incidence of pathology, reaching 20%. Concomitant rectocele, rectal mucosal prolapse causes obstructive defecation syndrome which is manifested in obstructive defecation and fecal incontinence. Until now, the problem of surgical treatment of this pathology has not been completely solved. Unsatisfactory results of treatment are observed in 30% of patients. The article presents the results of treatment of 18 patients. For descending perineum concomitant with rectocele and rectal mucosa prolapsed they were performed abdominal sacrocolpopexy using a synthetic implant. After surgery these patients were still complaining of persistent symptoms of obstructive defecation. With defecography, ultrasound, MRI, it was shown that, despite the correction of the of the perineum level, which was -3.2 ± 0.4 cm in the rest, -5.6 ± 0.5 cm during straining relative to the pubo-coccygeal line, 2.2 ± 0.3 cm rectocele size, which were correspond to norms, absence of vaginal apical prolapsed rectal mucosal prolapsed was observed in these patients. It was the cause of difficulty emptying the rectum. Thus, it was found that this pathology is not corrected by abdominal sacrocolpopexy. All patients were additionally performed stapled transanal rectum resection (STARR). There were no serious complications in the postoperative period. Defecography revealed the absence of rectal mucosal prolapse. All patients noted improvement of emptying function. It were confirmed by anorectal functional tests and by test with balloon ejection. Thus, in patients with perineum descending and the rectal mucosa prolapsed STARR procedure allows to improve the results of abdominal sacrocolpopexy.

Keywords:  perineum descending, rectocele, rectal mucosal prolapse, obstructive defecation, abdominal sacrocolporectopexy, STARR procedure

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