Urogynaecology, Department of Obstetrics and Gynaecology, Epsom & St Helier University Hospitals NHS Trust, London, UK.
Department of Obstetrics and Gynaecology, St. George's University of London, London, UK.
Int J Gynaecol Obstet. 2020 Feb;148(2):135-144. doi: 10.1002/ijgo.13006. Epub 2019 Nov 19.
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.
To provide an update of the previous clinical opinion report on conservative and surgical treatment of posterior compartment prolapse.
Search of evidence was performed using Pubmed, Embase, and Cochrane Library databases up to August 2018.
Controlled trials on posterior colporrhaphy, site-specific defect, transanal, abdominal, laparoscopic, and mesh repair.
Collective consensus on surgical outcomes was based on a decision-making process during meetings and multiple group consultations.
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.
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.
国际盆腔医学和重建外科研讨组（FWG）（2012-2015 年）在评估现有证据并提供实践建议方面达成了国际意见领袖的共识。
提供对先前关于保守和手术治疗后盆腔器官脱垂的临床意见报告的更新。
使用 Pubmed、Embase 和 Cochrane 图书馆数据库搜索截至 2018 年 8 月的证据。
后阴道修补术、特定部位缺陷、经肛门、经腹、腹腔镜和网片修复的对照试验。
手术结果的集体共识是基于会议期间的决策过程和多次小组咨询。
基本评估和保守治疗先于手术管理。手术技术通过阴道、经会阴、经肛门、经腹或腹腔镜途径进行。无网片的经阴道手术途径优于经肛门途径。由于没有后阴道修补术和腹腔镜直肠固定术的临床研究或随机对照试验，因此无法得出结论。
直肠膨出的治疗应包括患者病史、生活质量问卷，以及在存在复杂肛肠症状的情况下进行影像学和功能研究。关于最佳阴道后壁修复类型的证据仍然很少。需要随机对照试验来确定实现安全、有效和长期解剖和功能结果的最佳方法。
