Perspective Chapter: Surgical Management of Symptomatic Rectocele

Abstract

Rectocele is defined as a herniation of the anterior rectal wall through the posterior vaginal wall into the vaginal lumen caused by rectovaginal septum weakness. This entity is more common in postmenopausal female patients. Approximately one-third of adult women affected with pelvic organ prolapse have a significant impact on their quality of life and emotional well-being. Up to more than 90% of woman can be asymptomatic. In symptomatic cases, constipation, defecatory disorders such as obstructed syndrome (ODS) or incontinence, vaginal mass, and pelvic discomfort are the main complaints. Surgical treatment is indicated after failure of conservative management. Talking about ODS, nearly 20% of the patients need surgery. Surgical options can be classified as abdominal (being laparoscopic colposacropexy the technique of choice) or perineal approach. In the latter group, the alternatives are transanal (TA), transperineal (TP), and transvaginal (TV) approaches with or without prosthetic material or grafts. Native-tissue transvaginal approach should be preferentially performed as it has shown better results. Nowadays, there is no consensus on what the gold-standard technique is given the lack of strong evidence.