The rectouterine pouch is a bag-shaped extension of the peritoneum. It can be affected by different diseases such as endometriosis, abscesses or hernias. Procedures and operations in the rectouterine pouch are generally carried out laparoscopically or via the vagina or the rectum.

The rectouterine pouch is the lowest point of the abdominal cavity. In women, it is situated between the rectum and the uterus; in men, between the rectum and the bladder. There are three reasons for surgery in the rectouterine pouch: endometriosis, rectouterine abscess or a rectouterine hernia. In endometriosis, autonomous mucous membrane grows outside the uterine cavity similar to the uterine mucosa, e.g. in the Douglas cavity, but also in other places. A rectouterine abscess can develop from an infection of the abdominal cavity. A hernia and vaginal enterocele are often connected with discensus of the uterus.

Depending on the underlying disease, different procedures are carried out in the rectouterine pouch. The simplest procedure is a puncture in which fluid is aspirated. It takes place through the vagina or the rectum under local anaesthesia. Surgery in the rectouterine pouch is usually minimally invasive and carried out with keyhole technology.

What preparations are carried out before the procedure?

Different clarifications and examinations are undertaken before the procedure. Ultrasound examination, vaginal endoscopy or colonoscopy are some of the standard clarifications. All blood-thinning medication must be discontinued before the procedure takes place. The surgery is usually carried out under general anaesthetic along with all the usual pre-operative assessments.

How is the operation carried out?

Access to the rectouterine pouch is either gained laparoscopically through the abdominal wall or through the vagina or the rectum. Endometriosis lesions are removed. In the case of vaginal enterocele, the hernia is pushed back and the hernia pouch is closed with a suture.

The procedure takes one to two hours.

What is the success rate of this procedure?

The results depend on the underlying disease. This procedure usually remedies vaginal enterocele. In the case of endometriosis, lesions can sometimes reform.

What are the possible complications and risks of this procedure?

This is a low-risk operation and generally proceeds without complications. As with all surgery, the operation may lead to infections, post-operative haemorrhaging or blood clots in rare cases. Sometimes, growths can appear in the abdomen.

What happens after the operation?

After the surgery, the patient is monitored during the recovery phase as they wake up from the anaesthesia. If everything proceeds normally, you can usually leave hospital one or two days after the operation. You should avoid lifting heavy objects and major physical exertion for some time after the surgery, and refrain from sexual intercourse for a while. Depending on the underlying disease, regular follow-up check-ups are required.

Centres 5