title: Rectocele repair with stapled transvaginal rectal resection.
abstract: BACKGROUND
  Constipation is a clinical symptom in patients suffering from slow transit and/or obstructed defecation. Proper treatment requires the identification of all associated disorders and the quantification of symptoms. Rectocele can cause the symptoms of obstructed defecation syndrome (ODS). The aim of this study was to evaluate the clinical and functional outcomes of a novel technique of transvaginal stapled rectal resection (TVSRR) using a straight staple line, to treat rectocele.
  
  
  METHODS
  The study included 84 females [median age 51 years (range 29-73 years)], with obstructed defecation, grades II-III rectocele, and multiple abnormalities on defecography. The magnitude and degree of ODS were quantified by the Altomare ODS scoring system. Continence status was evaluated using the Pescatori scoring system. The rectal and vaginal manometric study, the index of patient satisfaction using a visual analog score (VAS), and the validated Patient Assessment of Constipation Quality of Life (PAC-QOL) questionnaire results were recorded. All patients underwent TVSRR.
  
  
  RESULTS
  There were no intraoperative complications. Early postoperative complications were defecatory urgency in seven patients (8.3 %), dyspareunia in two (2.4 %), and rectovaginal fistula in one (1.2 %). Five patients (6 %) had recurrence of ODS symptoms. There was no significant change in continence pre- and postoperatively. The ODS score and VAS revealed significant improvement within the first postoperative year in 94 % of patients. The PAC-QOL questionnaire mean total scores indicated an improvement in both the patient satisfaction and the QOL during the 12-month follow-up. The self-reported definitive outcome was excellent in 46 patients (54.7 %), good in 29 (34.5 %), fairly good in 20 (23.8 %), and poor in five (6.0 %).
  
  
  CONCLUSIONS
  Vaginal repair carries no risk of fecal incontinence. Large anterior rectocele is considered the main indication for this technique. Using the linear stapler is a cost-effective, simple, and easy technique.
authors.affiliation: Department of Surgery, Faculty of Medicine, Cairo University, 7, Gamal Salem St., Off Mossadak St., Dokki, Cairo, Egypt. shafik@ahmedshafik.com.
authors.forename: A A
authors.initials: AA
authors.lastname: Shafik
authors.affiliation: Department of Surgery, Faculty of Medicine, Menoufia University, Al Minufiya, Egypt.
authors.forename: O
authors.initials: O
authors.lastname: El Sibai
authors.affiliation: Department of Surgery, Faculty of Medicine, Cairo University, 7, Gamal Salem St., Off Mossadak St., Dokki, Cairo, Egypt.
authors.forename: I A
authors.initials: IA
authors.lastname: Shafik
mesh_terms: D000328:Adult; D000368:Aged; D003248:Constipation / Q000209:etiology / Q000523:psychology / Q000601:surgery; D003672:Defecation / Q000502:physiology; D019841:Defecography; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery*; D008875:Middle Aged; D017060:Patient Satisfaction; D011183:Postoperative Complications; D011446:Prospective Studies; D011788:Quality of Life; D020047:Rectocele / Q000150:complications / Q000601:surgery*; D012007:Rectum / Q000601:surgery; D017792:Surgical Stapling / Q000379:methods*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014621:Vagina / Q000601:surgery
keywords: Constipation; Linear stapler; Obstructed defecation; Rectocele; Vaginal repair