Enterocele repair

An enterocele is a herniation of the pelvic peritoneum and/or small bowel beyond the normal boundaries of the cul-de-sac. Endopelvic fascia supporting the anterior, apical or posterior vagina is deficient, allowing the vagina to prolapse and small bowel to fill the hernia sac. An enterocele classically causes apical and/or posterior vaginal wall prolapse as the small bowel dissects into the rectovaginal space. Anterior and/or posterior vaginal wall prolapse without concomitant apical prolapse is uncommon. Therefore, apical prolapse repair should be included in the majority of enterocele repairs. Outcome studies also show that restoration of the apex corrects nearly half of anterior vaginal wall defects and one-third of posterior defects.