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Surgical management of posterior vaginal defects

Authors
Amy J Park, MD
Tristi W Muir, MD
Marie Fidela R Paraiso, MD, FACOG
Section Editor
Linda Brubaker, MD, FACS, FACOG
Deputy Editor
Kristen Eckler, MD, FACOG

INTRODUCTION

The surgical approach to management of posterior vaginal wall defects (rectocele) will be discussed here. The clinical manifestations, diagnosis, and nonsurgical management of posterior vaginal defects are reviewed separately. (See "Clinical manifestations, diagnosis, and nonsurgical management of posterior vaginal defects".)

SURGICAL AND FUNCTIONAL ANATOMY

Histology — The apical portion of the posterior vaginal wall consists of mucosa (which includes the epithelium of the posterior wall and the lamina propria), a superficial and deep muscularis layer, and adventitia. This fibromuscularis layer has been called "rectovaginal fascia" and "perirectal fascia."

Histologic examination of the rectovaginal septum reveals that the distal portion near the perineal body contains dense connective tissue; the midportion has an adventitial layer containing fat, fibrous tissue, blood vessels, nerves, and elastic fibers; and the most proximal end is mostly adipose tissue [1]. The adipose tissue between the vaginal tube and rectum allows these two structures to function independently of one another.

Comparisons of the histology of women with and without prolapse have shown that the smooth muscle content of the posterior vaginal wall of women with prolapse is disorganized and significantly reduced compared to women without prolapse [2].

Normal anatomic support — The upper fourth of the posterior vaginal wall is suspended by the cardinal-uterosacral ligament complex. The middle half is attached laterally to the arcus tendineus fascia pelvis proximally and the arcus tendineus rectovaginalis distally. The lower fourth fuses into the perineal body.

                       

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Literature review current through: Nov 2016. | This topic last updated: Tue Feb 23 00:00:00 GMT 2016.
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