title: Defect-specific rectocele repair: medium-term anatomical, functional and subjective outcomes.
abstract: BACKGROUND
  Rectocele is a herniation of the anterior wall of the rectal ampulla through a defect in the rectovaginal septum causing protrusion of the posterior vaginal wall. Common symptoms include symptoms of prolapse and obstructed defecation.
  
  
  OBJECTIVE
  To describe subjective, anatomical and functional results of defect-specific rectocele repair.
  
  
  METHODS
  This is an internal audit of 137 women who underwent defect-specific rectocele repair. Pre- and post-operative assessment included a standardised interview, clinical examination and 3D/4D transperineal ultrasound. Outcome measures were symptoms of obstructed defecation, recurrent prolapse symptoms, clinical posterior compartment recurrence and rectocele recurrence on ultrasound.
  
  
  RESULTS
  At a mean follow-up of 1.4 years, 117 (85%) of women considered themselves cured or improved. Thirty-four (25%) complained of recurrent prolapse symptoms and 47 (34%) symptoms of obstructed defecation, a significant reduction (P < 0.0001). Clinical recurrence (Bp ≥ -1) was seen in 19 women (14%) and recurrence on ultrasound in 27 (20%). The mean depth of recurrence was 16.6 mm (10.3-25.1). We tested multiple potential predictors of recurrence, including age, BMI, vaginal parity, previous hysterectomy and/or prolapse surgery, follow-up time, pre-operative clinical and ultrasound findings. Only hiatal area on Valsalva (OR 0.95 for sonographic recurrence, P = 0.01) and enterocele (for clinical and sonographic recurrence, OR 4.03, P = 0.01 and OR 2.72, P = 0.02, respectively) reached significance.
  
  
  CONCLUSIONS
  Defect-specific rectocele repair is effective both in restitution of normal anatomy and in resolving prolapse and obstructed defecation symptoms at a mean follow-up of 1.4 years.
authors.affiliation: Departamento de Ginecología y Obstetricia, Facultad de Medicina, Clínica Alemana - Universidad del Desarrollo, Santiago, Chile.|Departamento de Ginecología y Obstetricia, Hospital Clínico de la Universidad de Chile, Santiago, Chile.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Guzmán Rojas
authors.affiliation: Department of Obstetrics and Gynaecology, Sydney Medical School Nepean, University of Sydney, Penrith, NSW, Australia.|Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.
authors.forename: Ixora
authors.initials: I
authors.lastname: Kamisan Atan
authors.affiliation: Department of Obstetrics and Gynaecology, Sydney Medical School Nepean, University of Sydney, Penrith, NSW, Australia.|Department of Obstetrics and Gynaecology, Liverpool Hospital, University of Western Sydney, Sydney, NSW, Australia.
authors.forename: Ka Lai
authors.initials: KL
authors.lastname: Shek
authors.affiliation: Department of Obstetrics and Gynaecology, Sydney Medical School Nepean, University of Sydney, Penrith, NSW, Australia.
authors.forename: Hans Peter
authors.initials: HP
authors.lastname: Dietz
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D013509:Gynecologic Surgical Procedures / Q000379:methods; D006801:Humans; D021621:Imaging, Three-Dimensional; D008875:Middle Aged; D016017:Odds Ratio; D063868:Patient Outcome Assessment; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D019651:Plastic Surgery Procedures / Q000379:methods; D020047:Rectocele / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D062606:Tertiary Care Centers; D016896:Treatment Outcome; D014463:Ultrasonography; D014596:Uterine Prolapse / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*
keywords: 3D/4D ultrasound; obstructed defecation; prolapse; rectocele; transperineal ultrasound