ABSTRACT
Background: Surgical treatment of rectocele and cystocele is usually performed in a
hospital setting under regional (spinal or epidural) or general anesthesia, and
patients commonly have to stay in the hospital for at least one or two days.
The possibility of performing the surgery under local anesthesia, as an
outpatient procedure with minimal bleeding and pain, no surgical assistants,
with immediate discharge and, most importantly, without compromising
postoperative results, is appealing. To our knowledge, no studies have evaluated
whether performing rectocele and/or cystocele rectocele repair under local
infiltration anesthesia and without separation of the vaginal mucosa from the
underlying fascia achieves these goals. Objective: The aim of this study is to describe a new surgical technique for
outpatient treatment of cystocele and rectocele under local anesthesia, and our
initial results. Materials and Methods: Forty women underwent outpatient
surgical repair of rectocele and/or cystocele between April and September 2020
at the ambulatory procedure room of the authors’ clinics. The technique
consists of a triangular-shaped CO2 laser vaporization or electrocauterization of the posterior and/or anterior
vaginal epithelium, followed by plication of the edges of the triangle with 0 polygalactin
suture. A perineorrhaphy was always performed concomitantly with rectocele
repair, and a transobturator sling was performed in women presenting with
concomitant stress urinary incontinence. Postoperative evaluation included
POP-Q measurement for each patient six months after the procedure, and
resolution of prolapse was considered when anterior and/or posterior vaginal
wall presented as stage 0 or 1. Pre and postoperative POP-Q measurements were analyzed
using Wilcoxon signed-rank test. Results: The mean operating time was 21 minutes (range: 14 - 38
minutes). All patients tolerated the procedure well and were discharged
immediately afterwards. There were no intraoperative or postoperative complications,
and all patients had satisfactory healing of the vaginal mucosa. Bleeding from
the rectocele and/or cystocele repair was minimal, and nobody required
extra-anesthesia or transfer to a hospital surgical theater. At six month
follow-up, pre and postoperative POP-Q measurements of
points 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 satisfactory
resolution of both rectocele and cystocele. Conclusion: Our initial results suggest that rectocele and cystocele may be safely
and effectively treated under local anesthesia in an outpatient setting using
this new technique.