Randomized controlled trial between perineal and anal repairs of rectocele in obstructed defecation.
OBJECTIVE
The present study was designed to evaluate functional outcome of perineal repair with and without levatorplasty versus transanal repair of rectocele in obstructed defecation.


METHODS
A total of 48 multiparous women with obstructed defecation caused by a rectocele were randomly allocated to three groups: transperineal repair with levatorplasty (TPR-LP; n = 16); transperineal repair without levatorplasty (TPR; n = 16); and transanal repair (TAR; n = 16). The study included defecographic assessment, anal manometry, symptom improvement, sexual function, and score on a function questionnaire. Assessments were done preoperatively and 6 months postoperatively.


RESULTS
Defecography showed significant reduction in size of rectocele in all groups. Constipation improved significantly in both groups with transperineal repair but not in the group with transanal repair. Significant reductions in mean anal resting pressure, maximum reflex volume, and urge-to-defecate volume were observed only with the transperineal approach (with and without levatorplasty). Functional score improved significantly in the transperineal groups (with levatorplasty, P < 0.001; without levatorplasty, P < 0.01), but not in the transanal group (P = 0.142). Levatorplasty added to transperineal repair significantly improved the overall functional score compared with transperineal repair alone (P < 0.01) and transanal repair TAR (P < 0.001).


CONCLUSIONS
Rectocele repair appears to improve anorectal function by improving rectal urge sensitivity. Transperineal repair of rectocele is superior to transanal repair in both structural and functional outcome. Levatorplasty improves functional outcome, but potential effects on dyspareunia should be discussed with the patient.
Farid
Mohamed
M
Department of Surgery, University of Mansoura, Mansoura, Egypt.
Madbouly
Khaled M
KM
Hussein
Ahmed
A
Mahdy
Tarik
T
Moneim
Hesham A
HA
Omar
Waleed
W
D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D003248:Constipation / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D003672:Defecation / Q000502:physiology; D019841:Defecography; D005260:Female; D006801:Humans; D008365:Manometry; D008875:Middle Aged; D010502:Perineum / Q000601:surgery*; D020127:Recovery of Function; D020047:Rectocele / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D011795:Surveys and Questionnaires