title: Functional and physiological outcome following transanal repair of rectocele.
abstract: BACKGROUND
  Rectoceles are traditionally repaired transvaginally and sexual dysfunction can be a significant complication. The aim of this study was to evaluate the functional and physiological outcome following transanal repair of rectoceles.
  
  
  METHODS
  Forty-five patients of mean age 57.1 (range 34-78) years with a symptomatic anterior rectocele, selected by contrast retention greater than 15 per cent on isotope defaecography, underwent transanal repair of rectocele. Preoperative and postoperative symptoms were assessed by means of a questionnaire. A proportion of patients underwent anorectal physiology and isotope defaecography before and after surgery.
  
  
  RESULTS
  Median(range) follow-up was 24 (2-50) months. One patient developed a wound infection after surgery. Thirty-five patients reported an excellent, good or fair result, with seven reporting a moderate and three a poor result. There was a reduction in incomplete evacuation (P < 0.001) confirmed by isotope defaecography (mean(s.d.) rectal emptying before surgery 57(14) per cent versus 76(9) per cent after surgery; P = 0.020), and a reduction in vaginal (P < 0.001) and perineal (P = 0.004) digitation. Symptomatic feeling of prolapse (vaginal bulging) was significantly improved (P < 0.001). There was no increase in incontinence (P = 0.688). Resting and squeeze anal canal pressures were unchanged after operation. Surgery did not result in sexual dysfunction.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Colorectal Surgery, St George's Hospital, London, UK.
authors.forename: A G
authors.initials: AG
authors.lastname: Heriot
authors.forename: A
authors.initials: A
authors.lastname: Skull
authors.forename: D
authors.initials: D
authors.lastname: Kumar
mesh_terms: D000328:Adult; D000368:Aged; D002400:Cathartics / Q000627:therapeutic use; D003672:Defecation / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods; D011300:Preoperative Care / Q000379:methods; D011312:Pressure; D020047:Rectocele / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D002400:Cathartics