title: Rectocele repair by anterolateral rectopexy: long-term functional outcome.
abstract: BACKGROUND
  Rectoceles are frequently associated with feelings of pelvic discomfort and symptoms of obstructed defaecation (OD). Repair by a transvaginal or transanal approach might result in de novo dyspareunia in up to approximately 40% of the cases. This study was designed to investigate whether anterolateral rectopexy provides an adequate rectocele repair without dyspareunia as a side effect.
  
  
  METHODS
  A consecutive series of 33 women (median age 55 years; range: 37-73) with a symptomatic rectocele (depth > 3 cm) underwent anterolateral rectopexy. Before the operation, all patients underwent evacuation proctography (EP), which was repeated 6 months after the repair in all but three patients. A standardized questionnaire concerning pelvic discomfort, OD and dyspareunia was used to assess the long-term effect of rectocele repair. The response rate was 91%.
  
  
  RESULTS
  Six months after the procedure, EP revealed a recurrent or persistent rectocele in six patients (20%). However, in four of these six patients, the depth of the rectocele was < 3 cm. The median duration of follow-up was 74 months (range: 2-96). Among the patients with an adequate repair, signs of OD persisted in 55%. None of the patients encountered de novo dyspareunia after the procedure.
  
  
  CONCLUSIONS
  Anterolateral rectopexy provides an effective tool for anatomical correction of rectoceles and does not result in dyspareunia as a side effect. However, despite adequate repair, OD persist in the majority of patients.
authors.affiliation: Colorectal Research Group of the Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: D M J
authors.initials: DM
authors.lastname: Oom
authors.forename: M P
authors.initials: MP
authors.lastname: Gosselink
authors.forename: J J
authors.initials: JJ
authors.lastname: van Wijk
authors.forename: V R M
authors.initials: VR
authors.lastname: van Dijl
authors.forename: W R
authors.initials: WR
authors.lastname: Schouten
mesh_terms: D000328:Adult; D000368:Aged; D013505:Digestive System Surgical Procedures; D004312:Douglas' Pouch / Q000601:surgery; D004414:Dyspareunia / Q000453:epidemiology; D005260:Female; D006627:Hirschsprung Disease; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D020127:Recovery of Function; D020047:Rectocele / Q000601:surgery*; D013536:Suture Techniques; D016896:Treatment Outcome