TY - JOUR
AU - Ansari, A
AB - Abstract The Editors welcome topical correspondence from readers relating to articles published in the Journal. Responses should be sent electronically via the BJS website (www.bjs.co.uk). All letters will be reviewed and, if approved, appear on the website. A selection of these will be edited and published in the Journal. Letters must be no more than 250 words in length. Sir We congratulate D'Hoore and colleagues on excellent results combining laparoscopic ventral rectopexy, perineal mesh, rectal/levator fixation, levatorplasty and mesh sacropexy. This ‘belt-and-braces’ approach, recently reported by others1, confuses the range of conditions to which the authors refer. Separation of this eclectic group of patients needs to be made between those with obstructed defaecation who have a correctable rectocele with a coincident enterocele, vaginal vault prolapse or a perineocele. In this study it is unclear how many patients were post-hysterectomy, where enteroceles with or without vault prolapse are more common when hysterectomy was not combined with a sacrocolpopexy or culdeplasty2. The multiplicity of pelvic floor pathologies, and the consultant to which the patient is referred, governs the decision for abdominal, endorectal, transvaginal or transperineal surgery. Rectocele surgery has largely been written by gynaecologists performing posterior colporrhaphy with routine levator plication as a traditional ‘elytorrhaphy,’ designed to narrow the genital hiatus without recognition of its effect on bowel function. Gynaecological emphasis currently focuses on the significance of clinical and transintroital/translabial sonographic diagnosis of levator tears necessitating placation3; a view which has the potential of producing a rash of patients with defaecation difficulty. The issue has further been ‘complicated’ by the large numbers of stapled transanal rectal resection (STARR) procedures being performed where two separate dialogues of functional outcome have emerged; one extolling the virtues of a ‘one-cure-fits-all’ approach, with the other cautioning against serious and somewhat intractable post-STARR side-effects4. There is a necessity for multi-institutional, randomized controlled trials of the different surgical approaches directed towards clinicoradiological patient subclassification. References 1 Slawik S , Soulsby R, Carter H, Payne H, Dixon AR. Laparoscopic ventral rectopexy, posterior colpor-rhaphy and vaginal sacrocolpopexy for the treatment of recto-genital prolapse and mechanical outlet obstruction . Colorectal Dis 2008 ; 10 : 138 – 143 . Google Scholar PubMed OpenURL Placeholder Text WorldCat 2 Montella JM , Morrill MY. Effectiveness of the McCall culdeplasty in maintaining support after vaginal hysterectomy . Int Urogynecol J Pelvic Floor Dysfunct 2005 ; 16 : 226 – 229 . Google Scholar Crossref Search ADS PubMed WorldCat 3 Dietz HP , Shek C. Validity and reproducibility of the digital detection of levator trauma . Int Urogynecol J Pelvic Floor Dysfunct 2008 ; 19 : 1097 – 1101 . Google Scholar Crossref Search ADS PubMed WorldCat 4 Pescatori M , Zbar AP. Reinterventions after complicated or failed STARR procedure . Int J Colorect Dis 2008 ; [Epub ahead of print]. Google Scholar OpenURL Placeholder Text WorldCat Copyright © 2009 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model) Copyright © 2009 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
TI - Clinical, physiological and radiological assessment of rectovaginal septum reinforcement with mesh for complex rectocele (Br J Surg 2008; 95: 1264–72)
JF - British Journal of Surgery
DO - 10.1002/bjs.6582
DA - 2009-02-17
UR - https://www.deepdyve.com/lp/oxford-university-press/clinical-physiological-and-radiological-assessment-of-rectovaginal-Btk5VYbcDB
SP - 322
EP - 322
VL - 96
IS - 3
DP - DeepDyve
ER -