Techniques in Coloproctology

, Volume 17, Issue 4, pp 449–454 | Cite as

Transvaginal perineal body repair for low rectocele

  • P. PetrosEmail author
  • H. Inoue
How I Do It


We describe our technique of low rectocele repair which is based on the approximation and lifting of the laterally displaced perineal bodies (PBs) using the Tissue Fixation System©, a 7-mm-wide tensioned macropore polypropylene sling. In low rectocele, the PB between the rectum and vagina is thinned and laterally displaced but still attached to the deep transverse perineal (DTP) muscle. Our technique is described with the aid of a video. The vagina and rectum are dissected off the laterally displaced PBs. The DTP attachment of each PB to the descending ramus is identified per rectum. A tunnel is created in the DTP on both sides to insert the polypropylene mesh attached to an anchor. The loop of tape between the anchors is shortened via the one-way system at the base of the anchor to elevate the inferolaterally displaced PBs to a more medial position. This is infiltrated by collagen over time, creating a “neo-central tendon.” The musculofascial layer of the rectum, the vagina, and superficial layers of the PBs are approximated. Our cure rate for low rectocele repair was in excess of 90 %, even with an early version of this procedure. Our method differs from rectocele repair with large mesh in that it precisely mimics the damaged structure and uses only very short thin strips of tape to approximate and reinforce PBs weakened by birth injury and age.


Perineal body Rectocele Descending perineal syndrome Tissue Fixation System Constipation Obstructed defecation 


Conflict of interest

Peter Petros is the inventor of the TFS instrument and method. Hiromi Inoue has no conflict of interest.

Supplementary material

Supplementary material 1 (MOV 144161 kb)

Supplementary material 2 (MOV 191541 kb)


  1. 1.
    Petros P, Swash M, Bush M, Fernandez M, Gunnemann A, Zimmer M (2012) Defecation 1—testing a hypothesis for pelvic striated muscle action to open the anorectum, Tech Coloproctol. doi: 10.1007/s10151-012-0861-2
  2. 2.
    Petros PE (2010) The female pelvic floor, ch 4: reconstructive pelvic floor surgery according to the integral theory. Springer, Heidelberg, pp 118–218Google Scholar
  3. 3.
    Petros PE, Del Amo E, Wagenlehner F (2012) TFS perineal body repair for manually assisted defecation, TFS workshop at the annual meeting of the International Society for Pelviperineology, Yokohama Japan, 25th October 2012Google Scholar
  4. 4.
    Inoue H (2012) 337 TFS operations for prolapse 2007–2012, TFS workshop at the Annual Meeting of the International Society for Pelviperineology, Yokohama Japan, 25th October 2012Google Scholar
  5. 5.
    Sekiguchi Y, Kinjyo M, Inoue H, Sakata H, Kubota Y (2009) Outpatient mid urethral tissue fixation system sling for urodynamic stress urinary incontinence. J Urol 182:2810–2813PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2013

Authors and Affiliations

  1. 1.Academic Department of Surgery, St Vincent’s Hospital Clinical SchoolUniversity of New South WalesSydneyAustralia
  2. 2.Urogynaecology CenterShonan Kamakura General HospitalKamakuraJapan

Personalised recommendations