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• W3161150147 abstract "Background: Surgical treatment of rectocele and cystocele is usually performed in ahospital setting under regional (spinal or epidural) or general anesthesia, andpatients commonly have to stay in the hospital for at least one or two days.The possibility of performing the surgery under local anesthesia, as anoutpatient procedure with minimal bleeding and pain, no surgical assistants,with immediate discharge and, most importantly, without compromisingpostoperative results, is appealing. To our knowledge, no studies have evaluatedwhether performing rectocele and/or cystocele rectocele repair under localinfiltration anesthesia and without separation of the vaginal mucosa from theunderlying fascia achieves these goals. Objective: The aim of this study is to describe a new surgical technique foroutpatient treatment of cystocele and rectocele under local anesthesia, and ourinitial results. Materials and Methods: Forty women underwent outpatientsurgical repair of rectocele and/or cystocele between April and September 2020at the ambulatory procedure room of the authors’ clinics. The techniqueconsists of a triangular-shaped CO2 laser vaporization or electrocauterization of the posterior and/or anteriorvaginal epithelium, followed by plication of the edges of the triangle with 0 polygalactinsuture. A perineorrhaphy was always performed concomitantly with rectocelerepair, and a transobturator sling was performed in women presenting withconcomitant stress urinary incontinence. Postoperative evaluation includedPOP-Q measurement for each patient six months after the procedure, andresolution of prolapse was considered when anterior and/or posterior vaginalwall presented as stage 0 or 1. Pre and postoperative POP-Q measurements were analyzedusing Wilcoxon signed-rank test. Results: The mean operating time was 21 minutes (range: 14 - 38minutes). All patients tolerated the procedure well and were dischargedimmediately afterwards. There were no intraoperative or postoperative complications,and all patients had satisfactory healing of the vaginal mucosa. Bleeding fromthe rectocele and/or cystocele repair was minimal, and nobody requiredextra-anesthesia or transfer to a hospital surgical theater. At six monthfollow-up, pre and postoperative POP-Q measurements ofpoints Ap, Bp, Aa and Ba were all statistically significant(Ap 1.6 ± 1.2 × -2.4 ± 0.9, Bp 2.6 ± 1.6 × -2.7 ± 1.4, Aa 1.4 ± 1.1 × -2.3 ±0.8, and Ba 2.4 ± 1.5 × -2.5 ± 1.2) respectively, revealing satisfactoryresolution of both rectocele and cystocele. Conclusion: Our initial results suggest that rectocele and cystocele may be safelyand effectively treated under local anesthesia in an outpatient setting usingthis new technique." @default.
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• W3161150147 date "2021-01-01" @default.
• W3161150147 modified "2023-10-18" @default.
• W3161150147 title "Bloodless Outpatient Surgical Treatment of Rectocele and Cystocele under Local Anesthesia" @default.
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• W3161150147 doi "https://doi.org/10.4236/ojog.2021.115053" @default.
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