Enterocele Surgery

Enterocele Surgery – Clinical Guide

What is an Enterocele?

An enterocele is the prolapse of the small intestine towards the posterior vaginal wall and is usually associated with loss of apical pelvic support.

Surgical Indications

• Symptomatic advanced enterocele
• Vaginal fullness and pressure sensation
• Concomitant pelvic organ prolapse
• Failure of conservative treatment

Surgical Goal

To restore the small intestine to its normal anatomical position in the pelvic cavity and to provide apical support.

1. Vaginal Approach

The enterocele sac is dissected and closed via the vaginal route, and apical support is provided.

2. Uterosacral Ligament Suspension

The vaginal cuff or uterus is supported by suspending it to the uterosacral ligaments.

3. Sacrospinous Fixation

The vaginal cuff is fixed to the sacrospinous ligament. Apical support is provided.

4. Abdominal / Laparoscopic Approach

With methods such as sacrocolpopexy, apical support can be provided with mesh or native tissue.

Advantages

• Provides anatomical correction
• Reduces symptoms
• Can be performed with combined surgeries

Disadvantages

• Risk of recurrence
• Surgical complications

Combined Surgeries

Since enterocele often coexists with cystocele, rectocele, or uterine prolapse, it can be corrected in the same session.

Post-Surgery

• Avoid heavy lifting
• Prevent constipation
• Perform pelvic floor exercises
• Sexual intercourse is not recommended for 4–6 weeks

Complications

• Infection
• Bleeding
• Recurrence
• Pain

Clinical Fact

Apical support must be provided for a successful outcome. Posterior repair alone may not be sufficient.

Conclusion

Enterocele surgery has a high success rate with the correct technique and patient selection. Apical support is the cornerstone of the surgery.