Symptomatic rectocele: what are the indications for repair?
BACKGROUND
The surgical indications for symptomatic rectocele are undefined, and surgery has high recurrence rates. We implemented magnetic resonance imaging defecography (MRID) to determine if utilizing strict inclusion criteria for rectocele repair improves outcomes.


METHODS
Patients with obstructive defecation syndrome (ODS) who underwent dynamic MRID were evaluated. Indications for surgical repair were defecation requiring manual assistance and the following MRID results: anterior defect >2 cm, incomplete evacuation, and the absence of perineal descent. Primary outcomes were the change in quality of life (QOL) scores and recurrence.


RESULTS
From 2006 to 2013, 143 patients who presented with ODS underwent MRID. Seventeen patients met the criteria for repair. Recurrence was low (5.8%) with a median follow-up of 23 months, QOL scores improved from 57.3 to 76.5 (P = .041).


CONCLUSIONS
A minority of patients (12%) with ODS met the above criteria for rectocele repair. Patients who underwent repair had a significant improvement in QOL and low recurrence rate.
Department of Surgery, Division of Colorectal Surgery, University Hospitals Case Medical Center, Case Western Reserve Medical School, 11100 Euclid Avenue, Cleveland, OH, USA. Electronic address: Glenn.Hall@uhhospitals.org.
Glenn M
GM
Hall
Department of Surgery, Division of Colorectal Surgery, University Hospitals Case Medical Center, Case Western Reserve Medical School, 11100 Euclid Avenue, Cleveland, OH, USA.
Skandan
S
Shanmugan
Department of Surgery, Division of Colorectal Surgery, University Hospitals Case Medical Center, Case Western Reserve Medical School, 11100 Euclid Avenue, Cleveland, OH, USA.
Tamar
T
Nobel
Department of Surgery, Division of Colorectal Surgery, University Hospitals Case Medical Center, Case Western Reserve Medical School, 11100 Euclid Avenue, Cleveland, OH, USA.
Raj
R
Paspulati
Department of Surgery, Division of Colorectal Surgery, University Hospitals Case Medical Center, Case Western Reserve Medical School, 11100 Euclid Avenue, Cleveland, OH, USA.
Conor P
CP
Delaney
Department of Surgery, Division of Colorectal Surgery, University Hospitals Case Medical Center, Case Western Reserve Medical School, 11100 Euclid Avenue, Cleveland, OH, USA.
Harry L
HL
Reynolds
Department of Surgery, Division of Colorectal Surgery, University Hospitals Case Medical Center, Case Western Reserve Medical School, 11100 Euclid Avenue, Cleveland, OH, USA.
Sharon L
SL
Stein
Department of Surgery, Division of Colorectal Surgery, University Hospitals Case Medical Center, Case Western Reserve Medical School, 11100 Euclid Avenue, Cleveland, OH, USA.
Bradley J
BJ
Champagne
D000368:Aged; D019841:Defecography; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D020047:Rectocele / Q000175:diagnosis* / Q000601:surgery*
Magnetic resonance imaging defecography (MRID); Obstructive defecation syndrome (ODS); Rectocele; Stapled transanal rectal resection (STARR)