Surgical Treatment for Rectocele by Posterior Colporrhaphy Compared to Stapled Transanal Rectal Resection

Abstract

Background: Rectocele is defined as a defect in the rectovaginal septum, causing symptoms like obstructed defecation syndrome (ODS), vaginal bulging, etc. Once the rectocele is larger than 3 cm and/or symptomatic, surgery should be considered. The surgical approach can be either transvaginal, transanal or transperineal. Two of the most common procedures in treating rectocele are posterior colporrhaphy (PC) and stapled trans anal rectal resection (STARR). The purpose of this study was to compare surgical outcomes of both procedures. Methods: This is a retrospective cohort study. Included were patients of the age of 18–85 years that underwent either STARR (n = 49 patients) or PC (n = 24 patients) procedures after a full clinical (defecography and physical exam before and after the surgery) and physiologic (a detailed questionnaire before and after the surgery) surveys. Symptoms of ODS before and after surgery were evaluated by questioners. Results: Preoperatively, the patients in the STARR group had significantly higher rates of ODS: straining (90.9% vs. 65.2%), incomplete evacuation (100% vs. 69.6%), hard stool (57.8% vs. 43.5%), sense of obstruction (76.1% vs. 56.5%), and use of digitation (64.4% vs. 47.8%), or laxatives (70% vs. 47.8%), p < 0.001. Anatomically, the mean rectocele size was smaller for the STARR group, compared to the PC group (3.8 ± 1.4 vs. 5.3 ± 2.2 cm, respectively, p < 0.001). Postoperatively, in the STARR group, higher rates of patients complained about straining (36.4% vs. 21.7%, p < 0.001) and use of digitation (64.4% vs. 26.1%, p < 0.001), whereas lower rates of patients complained about incomplete evacuation (41.2% vs. 56.5%, p = 0.05) and sense of obstruction (17.6%, vs. 34.8%, p = 0.03), compared to the PC group. Among patients who underwent the STARR procedure, a decrease in rates of all symptoms was noted (straining 54.5%, incomplete evacuation 58.8%, hard stool 29.2%, sense of obstruction 58.5%, use of digitation 0.1%, and use of laxatives 31.5%). Both procedures are effective in reducing rectocele size (STARR- 1.9 ± 1 cm, PC- 3.1 ± 1). Conclusions: Both STARR and PC are effective in treating rectocele. It seems that the STARR procedure is superior to the PC procedure in treating symptoms of ODS.

Surgical Treatment of Rectal Prolapse: Preoperative Evaluation and Surgical Options

“…Rectocele is characterised by the protrusion of the rectum into the vaginal cavity. This occurrence results from damage to the posterior compartment, leading to the weakening of the posterior vaginal wall support [10], or it can involve the herniation of the anterior rectal wall into the posterior vagina [11]. Enterocele, on the other hand, entails the compression of the small intestine against the rectal wall, typically occurring in patients with an abnormal deep Douglas pouch.…”

“…• Epiplooncele: the presence of epiploon in the deepest part of the Douglas cavity It is worth noting that internal rectal prolapse and rectocele frequently coexist. Rectocele is diagnosed in more than half of women presenting with pelvic floor disorders [10], although its true incidence and pathogenesis remain subject to controversy [11]. In approximately 80% of cases, rectocele coexists with an internal rectal prolapse, whereas isolated rectocele is found in only 10% of cases [13].…”

“…Surgical intervention is recommended when rectocele is symptomatic; however, if a nonsymptomatic rectocele is discovered, surgical intervention is not advised. The primary objective of surgical treatment for this type of functional pathological finding is symptom resolution [10].…”

“…Some authors have identified significant correlations between pelvic floor disorders and certain factors, including a younger age at first delivery, a higher body mass index, forceps delivery, and a history of previous gynaecologic surgery [2,10].…”