Rectocele repair by anterolateral rectopexy: long-term functional outcome.
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.
Oom
D M J
DM
Colorectal Research Group of the Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands.
Gosselink
M P
MP
van Wijk
J J
JJ
van Dijl
V R M
VR
Schouten
W R
WR
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