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Transanal or Vaginal Approach to Rectocele Repair: A Prospective, Randomized Pilot Study

  • Original Contributions
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Diseases of the Colon & Rectum

PURPOSE

This study was designed to compare outcomes of transanal and vaginal techniques for rectocele repair.

METHODS

Thirty females with symptomatic rectocele were enrolled in a prospective, randomized study. Fifteen underwent transanal rectoceleplasty, the other 15 underwent vaginal posterior colporrhaphy. Patients were assessed by clinical interview and examination, defecography, colon transit study, and anorectal manometry before randomization and 12 months postoperatively. Patients with compromised anal sphincter function or other symptomatic prolapse were excluded.

RESULTS

The study groups were comparable in terms of demographic factors and rectocele-related symptoms and signs. Eleven (73 percent) patients in the vaginal group and 10 (66 percent) in the transanal group digitally assisted rectal emptying preoperatively. The mean depth of the rectocele was 6.0 ± 1.6 cm vs. 5.6 ± 1.8 cm (P = 0.53) in the respective groups. At follow-up, 14 (93 percent) patients in the vaginal group and 11 (73 percent) in the transanal group reported improvement in symptoms (P = 0.08). Need to digitally assist rectal emptying decreased significantly in both groups, to one (7 percent) for the vaginal group and four (27 percent) for the transanal group (P = 0.17 between groups). The respective recurrence rates of rectocele were one (7 percent) vs. six (40 percent) (P = 0.04), and enterocele rates were zero vs. four (P = 0.05). In the vaginal group defecography showed a significant decrease in rectocele depth whereas in the transanal group the difference did not reach statistical significance. None of the patients reported de novo dyspareunia, but 27 percent reported improvement.

CONCLUSION

Patients’ symptoms were significantly alleviated by both operative techniques. The transanal technique was associated with more clinically diagnosed recurrences of rectocele and/or enterocele. Adverse effects on sexual life were avoided by use of both techniques.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland

    Kari Nieminen M.D. & Pentti K. Heinonen M.D.

  2. Medical School, University of Tampere, Tampere, Finland

    Kari Nieminen M.D. & Pentti K. Heinonen M.D.

  3. Department of Surgery, Tampere University Hospital, Tampere, Finland

    Kari-Matti Hiltunen M.D.

  4. Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland

    Jukka Laitinen M.D.

  5. Department of Radiology, Tampere University Hospital, Tampere, Finland

    Juha Oksala M.D.

Authors
  1. Kari Nieminen M.D.
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  2. Kari-Matti Hiltunen M.D.
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  3. Jukka Laitinen M.D.
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  4. Juha Oksala M.D.
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  5. Pentti K. Heinonen M.D.
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Correspondence to Kari Nieminen M.D..

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Supported by a grant from the Medical Research Fund of Tampere University Hospital and the Research Fund of the Finnish Gynecologic Association.

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Nieminen, K., Hiltunen, KM., Laitinen, J. et al. Transanal or Vaginal Approach to Rectocele Repair: A Prospective, Randomized Pilot Study. Dis Colon Rectum 47, 1636–1642 (2004). https://doi.org/10.1007/s10350-004-0656-2

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  • DOI: https://doi.org/10.1007/s10350-004-0656-2

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