The posterior compartment of the vagina comprises the zone from the cervix until to the perineal body where different key structures, which contain connective tissue, can be deteriorated as a result of a trauma (e. g complicated vaginal birth), previous hysterectomy or an increased body mass index. These structures include the uterosacral and cardinal ligaments, the rectovaginal fascia (RVF) and the perineal body (PB), all of them playing also an important role in the pathophysiology of other vaginal wall disorders (anterior and/or median vaginal defects). However, the grade of connective tissue disruption seems not to be correlated with the severity of the dysfunction. A posterior vaginal defect exteriorizes itself in the form of a rectocele, enterocele or sigmoidocele and it generally requires surgical repair when symptomatic with impact on the patient’s daily activities. The role of this review is to make a review of the literature regarding the possible transvaginal approaches to the posterior compartment defects, and namely the posterior colporrhaphy and repair of the RVF with or without grafts, focusing on the technique, success and recurrence rates of the different methods as well as the reasons to choose between different therapeutic options.
Key words: posterior compartment, rectocele, prolapse, rectovaginal fascia.
Abbreviations: RVF= rectovaginal fascia; PB= perineal body
A defect of the posterior vaginal wall is most often accompanied by disorders in the vaginal apex and/or the anterior and/or the median compartment and it generally produces an anterior herniation of the rectum in form of a rectocele, sigmoid colon as a sigmoidocele or the small bowel as an enterocele1. The most important structure of the posterior compartment is the rectovaginal fascia (RVF) which distally connects the posterior vaginal wall to the perineal body (PB) and cranially to the muscles of the levator plate2. The contraction of the levator plate opposes to the PB and stretches the PVW which is now horizontally orientated2,3. An intact RVF, uterosacral and cardinal ligaments, as well as an efficient contraction of the levator plate, prevents the herniation of the posterior wall of the rectum in the vagina, while the deterioration of the connective tissue of the proximal part of the RVF will cause an enterocele.