1. Introduction

2. Surgical Approach

3. Excise Anterior Wall Lappets

a. Identify Limits of Dissection

b. Inject Marcaine with Epinephrine

4. Preparation of Posterior Wall

a. Incision

b. Take Down Rectovaginal Tissue - Right Side

c. Take Down Rectovaginal Tissue - Left Side

5. Dissection

a. Approach

b. Restore Rectovaginal Septum

6. Reduce Rectocele

7. Trim Excess Vaginal Mucosa

8. Vaginal Epithelium Closure

9. Perineorrhaphy

10. Finish Vaginal Epithelium Closure

11. Final Rectal Exam

12. Post-op Remarks

The patient is a 38-year-old female who presented with fecal incontinence, constipation, and stress urinary incontinence. She was found to have stage II posterior vaginal wall prolapse. She desired definitive surgical management of her prolapse and opted for posterior vaginal repair. Although stress urinary incontinence was demonstrated on urodynamic testing, the decision was made not to proceed with concurrent mid-urethral sling given her history of pelvic floor dyssynergia and intermittent urinary retention. The surgery was uncomplicated, and she was discharged on the day of surgery. Her recovery was unremarkable.

Watch this full-length, narrated surgical video of a site-specific posterior colporrhaphy for repair of a rectocele performed at MGH.

Massachusetts General Hospital