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An update of a former FIGO Working Group Report on Management of Posterior Compartment Prolapse
Author(s) -
Doumouchtsis Stergios K.,
Raheem Ali Abdel,
Milhem Haddad Jorge,
Betschart Cornelia,
Contreras Ortiz Oscar,
Nygaard Christiana C.,
Medina Carlos A.,
La Torre Fillippo,
Iancu George,
Cervigni Mauro,
Zanni Giuliano
Publication year - 2020
Publication title -
international journal of gynecology and obstetrics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.895
H-Index - 97
eISSN - 1879-3479
pISSN - 0020-7292
DOI - 10.1002/ijgo.13006
Subject(s) - medicine , randomized controlled trial , surgery , pelvic floor , laparoscopy , medline , evidence based medicine , general surgery , alternative medicine , political science , law , pathology
Abstract Background The FIGO Working Group ( FWG ) in Pelvic Floor Medicine and Reconstructive Surgery (2012–2015) established a consensus among international opinion leaders in evaluating current evidence and providing practice recommendations. Objectives To provide an update of the previous clinical opinion report on conservative and surgical treatment of posterior compartment prolapse. Search strategy Search of evidence was performed using Pubmed, Embase, and Cochrane Library databases up to August 2018. Selection criteria Controlled trials on posterior colporrhaphy, site‐specific defect, transanal, abdominal, laparoscopic, and mesh repair. Data collection and analysis Collective consensus on surgical outcomes was based on a decision‐making process during meetings and multiple group consultations. Main results Basic evaluation and conservative treatment precede surgical management. Surgical techniques are performed by vaginal, transperineal, transanal, abdominal, or laparoscopic approach. The transvaginal surgical route without mesh appears superior to the transanal route. No conclusions can be drawn based on clinical studies or randomized controlled trials of posterior colporrhaphy and laparoscopic rectopexy. Conclusions Management of rectocele should include patients’ history, quality of life questionnaires, and, in case of complex anorectal symptoms, imaging and functional studies. Evidence on the best type of posterior vaginal wall repair is still scarce. Randomized controlled trials are needed to determine the best approach to achieve safe, effective, and long‐term anatomical and functional outcomes.