Functional and physiological outcome following transanal repair of rectocele

Abstract

Transanal repair of rectocele is a safe alternative to posterior colporrhaphy. It provides improvement in symptoms, reflected by anatomical improvement with minimal complications and no increase in dyspareunia.

Changes in Bowel Function following Transanal and Transvaginal Rectocele Repair

“…However, transanal repair may compromise anal sphincter pressure, although it is not considered to cause severe fecal incontinence postoperatively [11, 25, 26]. Other studies have not demonstrated any significant reduction of anal sphincter pressure [2, 11, 13, 16, 19], although a few have noted a reduction of threshold volume and/or rectal compliance [2, 11]. …”

“…The use of these physiologic investigations would be certainly advisable for comprehensive assessment of anorectal functional disorders. It is generally accepted that surgery for rectocele does not affect anal sphincter function as measured by manometry [1,2,3, 11, 12], though van Dam et al [26] reported a risk of impaired fecal continence after surgery.…”

“…Conversely, transanal repair is typically performed by colorectal surgeons, including a variety of new techniques [1, 2, 4, 8, 9, 11, 13, 16, 19, 25, 26]. This approach makes it possible to perform other procedures concurrently for the correction of simultaneous pelvic floor abnormalities including rectal prolapse/intussusception, fissure, and hemorrhoids [9].…”

“…Nonsurgical treatment includes pessaries, dietary modification, bulk-forming agents, and biofeedback therapy [22, 23]. If failed, surgery is indicated when the rectocele has a diameter >3 cm with symptoms of difficult or prolonged evacuation, sensation of incomplete emptying, retention of a specific amount of paste/isotope on defecography, or evacuation with digital assistance [1,2,3,4,5,6,7,8,9,10]. …”

“…Surgical intervention is indicated for large rectoceles with a diameter >3 cm and/or symptomatic rectoceles associated with obstructed defecation, incomplete emptying, or evacuation with digital support, as described in previous studies [1,2,3,4,5,6,7,8,9,10]. To date, various techniques of surgical repair for rectoceles have been introduced with a variety of outcomes [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20]. However, the most promising procedure for these patients in terms of postoperative clinical outcome has not been clearly established.…”