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Diseases of the Colon & Rectum

, Volume 43, Issue 11, pp 1556–1560 | Cite as

Analysis of patients with poor outcome of rectocele repair

  • J. H. van Dam
  • W. C. J. Hop
  • W. R. Schouten
Original Contributions

Abstract

PURPOSE: The aim of the present study was to analyze the prognostic value of clinical data and physiologic tests in patients undergoing rectocele repair for obstructed defecation. METHODS: Between 1988 and 1996, 89 consecutive female patients with obstructed defecation caused by a rectocele were enrolled in the study. Median age at time of presentation was 55 (range, 35–81) years. All patients underwent a combined transvaginal and transanal rectocele repair. End evaluation to assess long-term results was performed by an independent observer after a median duration of follow up of 52 (range, 12–92) months. The presence of the following five symptoms was evaluated: prolonged and unsuccessful straining at stool, feelings of incomplete evacuation, manual assistance during defecation, false urge to defecate, and a stool frequency of less than three times per week. When none or just one of these symptoms was present, outcome of rectocele repair was considered successful. The outcome was considered as a failure when two or more of these symptoms were recorded. Furthermore, all patients were asked to score the outcome of their operations as excellent, good, moderate, or poor. Clinical data and the results of physiologic tests obtained in patients with a poor outcome of surgery were compared with those obtained in patients with a successful outcome. RESULTS: Objective outcome of rectocele repair, based on the presence of symptoms, was found to be successful in 63 (71 percent) patients. Sixty-one patients considered outcome of surgery excellent or good (69 percent). Graded subjective outcomes between the two groups showed significantly better grades in cases of success. Duration of symptoms, number of symptoms, age, parity, and previous hysterectomy had no influence on the final outcome of surgery. Defecographic parameters, such as size of the rectocele, barium trapping in the rectocele, poor rectal evacuation, or intussusception, had no prognostic value. Signs of anismus based on defecography, electromyography, and balloon-expulsion studies did not influence outcome of surgery. The presence of symptoms such as defecation frequency, manual assistance, severe straining, false urge to defecate, or feelings of incomplete evacuation had no impact on the outcome. However, in patients without a daily urge to defecate or with a stool frequency of less than once per week, results of rectocele repair were significantly worse than in patients with a daily urge to defecate or a defecation frequency of more than once per week or both. In 14 of 26 patients with a poor outcome, colonic transit studies were performed. A delayed passage was observed throughout the entire colon in seven patients, in the left part of the colon and the rectosigmoid colon in four patients, and in the rectosigmoid colon in one patient. In two patients colonic transit was normal. CONCLUSIONS: Combined transvaginal and transanal rectocele repair is beneficial for the majority of patients with obstructed defecation. In patients without a daily urge to defecate or a stool frequency of less than once per week, indicating colonic malfunctioning, the outcome of rectocele repair seems to be poor.

Key words

Rectocele Symptoms Anismus Colonic inertia 

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References

  1. 1.
    Redding MD. The relaxed perineum and anorectal disease. Dis Colon Rectum 1965;8:279–82.Google Scholar
  2. 2.
    Sullivan ES, Leaverton GH, Hardwick CE. Transrectal perineal repair: an adjunct to improved function after anorectal surgery. Dis Colon Rectum 1968;11:106–14.Google Scholar
  3. 3.
    Capps WF Jr. Rectoplasty and perineoplasty for the symptomatic rectocele: a report of fifty cases. Dis Colon Rectum 1975;18:237–44.Google Scholar
  4. 4.
    Khubchandani IT, Sheets JA, Stasik JJ, Hakki AR. Endorectal repair of rectocele. Dis Colon Rectum 1983;26:792–6.Google Scholar
  5. 5.
    Sehapayak S. Transrectal repair of rectocele: an extended armamentarium of colorectal surgeons. A report of 355 cases. Dis Colon Rectum 1985;28:422–33.Google Scholar
  6. 6.
    Block IR. Transrectal repair of rectocele using obliterative suture. Dis Colon Rectum 1986;29:707–11.Google Scholar
  7. 7.
    Sarles JC, Arnaud A, Selezneff I, Olivier S. Endo-rectal repair of rectocele. Int J Colorectal Dis 1989;4:167–71Google Scholar
  8. 8.
    Arnold MW, Stewart WR, Aguilar PS. Rectocele repair: four years' experience. Dis Colon Rectum 1990;33:684–7.Google Scholar
  9. 9.
    Janssen LW, van Dijke CF. Selection criteria for anterior rectal wall repair in symptomatic rectocele and anterior rectal wall prolapse. Dis Colon Rectum 1994;37:1100–7.Google Scholar
  10. 10.
    Infantino A, Masin A, Melega E, Dodi G, Lise M. Does surgery resolve outlet obstruction from rectocele? Int J Colorectal Dis 1995;10:97–100.Google Scholar
  11. 11.
    Murthy VK, Orkin BA, Smith LE, Glassman LM. Excellent outcome using selective criteria for rectocele repair. Dis Colon Rectum 1996;39:374–8.Google Scholar
  12. 12.
    Karlbom U, Graf W, Nilsson S, Påhlman L. Does surgical repair of a rectocele improve rectal emptying? Dis Colon Rectum 1996;39:1296–302.Google Scholar
  13. 13.
    Khubchandani IT, Clancy JP, 3rd, Rosen L, Riether RD, Stasik JJ Jr. Endorectal repair of rectocele revisited. Br J Surg 1997;84:89–91.Google Scholar
  14. 14.
    Ho YH, Ang M, Nyam D, Tan M, Seow-Choen F. Transanal approach to rectocele repair may compromise anal sphincter pressure. Dis Colon Rectum 1998;41:354–8.Google Scholar
  15. 15.
    Kahn MA, Stuart SL. Posterior colporrhaphy: its effect on bowel and sexual function. Br J Obstet Gynaecol 1997;104:82–6.Google Scholar
  16. 16.
    Kahn MA, Stanton SL. Techniques of rectocele repair and their effects on bowel function. Intern Urogynecol J Pelvic Floor Dysfunct 1998;9:37–47.Google Scholar
  17. 17.
    Øster S, Astrup A. A new vaginal operation for recurrent and large rectocele using dermis transplants. Acta Obstet Gynecol Scand 1981;60:493–5.Google Scholar
  18. 18.
    Watson SJ, Loder PB, Halligan S, Bartram CI, Kamm MA, Philips RK. Transperineal repair of symptomatic rectocele with Marlex mesh: a clinical, physiological and radiologic assessment of treatment. J Am Coll Surg 1996;183:257–61.Google Scholar
  19. 19.
    Silvis R, Gooszen HG, Kahraman T,et al. Novel approach to combined defaecation and micturition disorders with rectovaginovesicopexy. Br J Surg 1998;85:813–7.Google Scholar
  20. 20.
    Ginai AZ. Technical report: evacuation proctography (defecography) a new seat and method of examination. Clin Radiol 1990;42:214–6.Google Scholar
  21. 21.
    van Dam JH, Ginai AZ, Gosselink MJ,et al. Role of defecography in predicting clinical outcome of rectocele repair. Dis Colon Rectum 1997;40:201–7.Google Scholar
  22. 22.
    van Dam JH, Schouten WR, Ginai AZ, Huisman WM, Hop WC. The impact of anismus on the clinical outcome of rectocele repair. Int J Colorectal Dis 1996;11:238–42.Google Scholar
  23. 23.
    Hinton JM, Lennard-Jones JE, Young AC. A new method for studying gut transit time using radiopaque markers. Gut 1969;10:842–7.Google Scholar
  24. 24.
    Mellgren A, Anzen B, Nilsson BY,et al. Results of rectocele repair: a prospective study. Dis Colon Rectum 1995;38:7–13.Google Scholar
  25. 25.
    Johansson C, Nilsson BY, Holmström B, Dolk A, Mellgren A. Association between rectocele and paradoxical sphincter response. Dis Colon Rectum 1992;35:503–9.Google Scholar
  26. 26.
    Pemberton JH, Rath DM, Ilstrup DM. Evaluation and surgical treatment of severe constipation. Ann Surg 1991;214:403–13.Google Scholar

Copyright information

© The American Society of Colon and Rectal Surgeons 2000

Authors and Affiliations

  • J. H. van Dam
    • 2
  • W. C. J. Hop
    • 1
  • W. R. Schouten
    • 2
  1. 1.the Department of Epidemiology and BiostatisticsUniversity Hospital DijkzigtRotterdamthe Netherlands
  2. 2.Department of General SurgeryHarbour HospitalRotterdamthe Netherlands

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