Transrectal repair of rectocele using obliterative suture.

Rectocele is a condition that can be repaired transrectally with an obliterative suture technique. The obliterative suture is essentially a tightly drawn continuous lock-stitch suture that strangulates the tissues contained in the suture line, and causes them to slough, yet approximates the tissues at the base of the suture line, the submucosa, and muscularis layers and allows them to heal rapidly. This technique is bloodless, easy to perform, and effective as far as cure and relief of symptoms. The time required for repair of the rectocele is approximately 6 minutes. The presence of a rectocele should be sought for routinely in every proctologic examination in the female. If anorectal surgery is to be performed, the rectocele should be repaired coincidentally, even if the rectocele is asymptomatic. If the rectocele is symptomatic, it should be repaired even if no other anorectal procedure is contemplated. The transrectal obliterative suture technique appears to have advantages over the vaginal or other transrectal techniques and is the method of choice for the repair of rectocele.

Levator ani as substitute puborectalis sling in treatment of anal incontinence.

For anal incontinence caused by destroyed or absent sphincter mechanism, a levator sling serving as a substitute puborectalis sling was used in five patients with incontinence of varied causes with good to excellent results. This sling was constructed bu freeing the insertion of the pubococcygeus and the ileococcygeus muscles from the coccyx. By further freeing the arcus tendineus from the lateral wall of the pelvis, the sling is made to arise from the pubis, thus theoretically giving the sling the potential of greater traction.

The Warren operation for anal incontinence caused by disruption of the anterior segment of the anal sphincter, perineal body, and rectovaginal septum: report of five cases.

The use of the Warren vaginal flap operation for repair of a traumatic deformity consisting of disruption of the perineal body, anterior segment of the external anal sphincter, and lower half of the rectovaginal septum is described. Modifications described in this article include use of the jackknife position to give better exposure and epinephrine infiltration to give a bloodless field. The incidences of infection and recurrence appear lower than with the layer technique.