title: Surgical technique for the transperineal approach of anterior levatorplasty and recto-vaginal septum reinforcement in rectocele patients with soiling and postoperative clinical outcomes.
abstract: OBJECTIVE
  To clarify the significance of a transperineal approach of anterior levatorplasty (ALP) and recto-vaginal septum reinforcement in rectocele patients with soiling, we reported the surgical technique and clinical outcomes two years after this operation.
  
  
  METHODS
  Twelve female patients (33-82 years, average 63.3) complaining of defecation disorders (disturbed defecation including excessive straining during defecation, sensation of incomplete defecation and manual assistance of digitation of the vagina) with soiling underwent the following surgical technique: under spinal anesthesia, rectal wall was opened up to the end of the rectal wall weakness. Rectocele in the weak rectal wall was horizontally sutured. Before closing wound ALP was fashioned.
  
  
  RESULTS
  In clinical outcomes, excessive straining during defecation, sensation of incomplete evacuation and defecation by manual assistance were statistically significantly reduced postoperatively after a follow-up of 2 years (p<0.01, p<0.01, p<0.0001, p<0.01, respectively). As an early postoperative complication, perineal wound infection was noted in one patient. Late postoperative complications were not noted in any patient. In overall patient satisfaction 2 years after operation, half of the patients were excellent and no patients were poor.
  
  
  CONCLUSIONS
  Combined repair of rectocele and ALP by transperineal approach may be a useful procedure for correcting rectocele with soiling. This procedure is also easy and safe.
authors.affiliation: Department of Surgery, Nippon Dental University Hospital, Tokyo, Japan. rtomita-ndus@mvg.biglobe.ne.jp
authors.forename: Ryouichi
authors.initials: R
authors.lastname: Tomita
authors.forename: Taro
authors.initials: T
authors.lastname: Ikeda
authors.forename: Shigeru
authors.initials: S
authors.lastname: Fujisaki
authors.forename: Kiminobu
authors.initials: K
authors.lastname: Sugito
authors.forename: Kenichi
authors.initials: K
authors.lastname: Sakurai
authors.forename: Tsugumichi
authors.initials: T
authors.lastname: Koshinaga
authors.forename: Masahiko
authors.initials: M
authors.lastname: Shibata
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000601:surgery*; D003672:Defecation; D019841:Defecography; D005260:Female; D006801:Humans; D008875:Middle Aged; D017060:Patient Satisfaction; D010502:Perineum / Q000601:surgery*; D020047:Rectocele / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D016896:Treatment Outcome; D014621:Vagina / Q000601:surgery*