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Comparative Study Between Trans-perineal Repair With or Without Limited Internal Sphincterotomy in the Treatment of Type I Anterior Rectocele: a Randomized Controlled Trial

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background and Aim

Two types of rectocele exist; type I is characterized by relatively high resting anal pressures, whereas type II has lower resting anal pressures with associated pelvic organ prolapse. We compared trans-perineal repair (TPR) of rectocele with or without limited internal sphincterotomy (LIS) in the treatment of type I anterior rectocele.

Patients and Interventions

Consecutive patients with anterior rectocele were evaluated for inclusion. Sixty-two female patients with type I anterior rectocele were randomized and equally allocated to receive TPR alone (group I) or TPR with LIS (group II). The primary outcome was the clinical improvement of constipation. Secondary outcomes were recurrence of rectocele, operative time, and postoperative complications including fecal incontinence (FI).

Results

Clinical improvement of constipation and patients’ satisfaction were significantly higher in group II at 1 year of follow-up (93.3 versus 70 %). Constipation scores significantly decreased in both groups postoperatively with more reduction being observed in group II (11.1 ± 2.1 in group I versus 8 ± 1.97 in group II). Significant reduction in the resting anal pressure was noticed in group II. Recurrence was recorded in three (10 %) patients of group I and one patient of group II. No significant differences between the two groups regarding the operative time and hospital stay were noted.

Conclusion

Adding LIS to TPR of type I rectocele achieved better clinical improvement than TPR alone. The only drawback of LIS was the development of a minor degree of FI, which was temporary in duration.

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Authors’ Contribution

Mohamed Youssef designed the study, performed the procedures, conducted the follow-up, and shared in the data analysis and writing of the manuscript.

Sameh Emile contributed to the follow-up of patients, data acquisition and analysis, and writing and drafting of the manuscript.

Waleed Thabet conducted the procedures, followed the patients, and shared in the data analysis and writing of the manuscript.

Hossam Elfeki contributed to the follow-up of patients, data acquisition and analysis, and writing and drafting of the manuscript.

Alaa Magdy contributed to the data interpretation and analysis and writing and drafting of the manuscript.

Waleed Omar conducted the procedures, followed the patients, and shared in the writing of parts of the manuscript and intellectual revision of the final version.

Wael Khafagy conducted the procedures, followed the patients, and shared in the writing of parts of the manuscript and intellectual revision of the final version.

Mohamed Farid designed the study, conducted the procedures, followed the patients, and shared in the writing of parts of the manuscript and intellectual revision of the final version.

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Authors and Affiliations

  1. General Surgery Department, Colorectal Surgery Unit, Mansoura Faculty of Medicine, Mansoura University Hospitals, El Gomhuoria Street, Mansoura City, Dakahlia Providence, Egypt

    Mohamed Youssef, Sameh Hany Emile, Waleed Thabet, Hossam Ayman Elfeki, Alaa Magdy, Waleed Omar, Wael Khafagy & Mohamed Farid

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  1. Mohamed Youssef
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  2. Sameh Hany Emile
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  3. Waleed Thabet
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  4. Hossam Ayman Elfeki
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  6. Waleed Omar
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Corresponding author

Correspondence to Sameh Hany Emile.

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Ethical approval of the institutional review board of Mansoura Faculty of Medicine was obtained.

Conflict of Interest

The authors declare that they have no conflict of interest

Footnote

The abstract of this article was previously presented as a poster presentation in the 10th annual meeting of the European Society of Coloproctology (ESCP) that took place from 22-25 September, 2015 in Dublin, Ireland.

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Youssef, M., Emile, S.H., Thabet, W. et al. Comparative Study Between Trans-perineal Repair With or Without Limited Internal Sphincterotomy in the Treatment of Type I Anterior Rectocele: a Randomized Controlled Trial. J Gastrointest Surg 21, 380–388 (2017). https://doi.org/10.1007/s11605-016-3299-4

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  • DOI: https://doi.org/10.1007/s11605-016-3299-4

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