Pelvic floor-lifting: an interdisciplinary repair of combined rectal and vaginal prolapse-5 years experience.

PURPOSE: Combined rectal and vaginal prolapse requires a complete repair of the pelvic floor that can only be achieved by an interdisciplinary management. We have, therefore, established a co-operation for preoperative diagnosis, interdisciplinary operations, and postoperative care involving a colorectal surgeon and a gynecologist.

METHODS

Our standardized operation, which we call the pelvic floor-lifting, is a combination of well-established colorectal and gynecological operative steps and the application of surgical principles for hernia repair. A non-absorbable mesh which is used for the Wells rectopexy is used, in addition, to perform a colpopexy and also a repositioning and pre-peritoneal mesh-reinforcement of the pouch of Douglas (Douglas-lifting). The optional final step of the operation is a Burch/Hirsch colposuspension.

RESULTS

We report on the satisfactory colorectal as well as gynecological results of 32 pelvic floor-lifting operations in a 5-year period. In addition, the outcomes of the operations were studied using quality-of-life questionnaires.

CONCLUSIONS

The feasibility of the pelvic floor-lifting operation was demonstrated. The Douglas-lifting, which is the repair of the Douglas hernia according to surgical principles, is the best possible preventive measure against repeat pelvic floor relaxation.