Skip to main content
SpringerLink
Log in

Failed Rectocele Repair

  • Chapter
  • First Online:
Reconstructive Surgery of the Rectum, Anus and Perineum

  • 2754 Accesses

Abstract

This chapter provides novel perspectives to the multidisciplinary assessment and management of patients who present with poor functional outcome and residual obstructed defecation, in particular after the range of surgeries available for symptomatic rectocele. The philosophy of transvaginal, endorectal, and transperineal approaches is discussed along with the initial indications, contraindications, and outcomes of endoanal stapled procedures (including the stapled transanal rectal resection [STARR] and trans-STARR operations) defining the surgical approaches to management of these challenging patients.

This chapter is a combined presentation by Drs. Altomare, Milito, and Caddedu concerning the failed rectocele repair and approaches to surgical investigation and management. The addendum at the end of this chapter is presented by Dr. Filippo Pucciani as part of the reoperative transperineal approach to recurrent rectocele.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 219.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 279.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Lefevre R, Davila GW. Functional disorders: rectocele. Clin Colon Rectal Surg. 2008;21:129–37.

    Article  PubMed  Google Scholar 

  2. Goh JTW, Tjandra JJ, Carey MP. How could management of rectocele be optimized? ANZ J Surg. 2002;72:896–901.

    Article  PubMed  Google Scholar 

  3. Stojkovic SG, Balfour L, Burke D, Finan PJ, Sagar PM. Does the need to self-digitate or the presence of a large or nonemptying rectocoele on proctography influence the outcome of transanal rectocoele repair? Colorectal Dis. 2003;5:169–72.

    Article  PubMed  CAS  Google Scholar 

  4. Arnold MW, Stewart WR, Aguilar PS. Rectocele repair. Four years’ experience. Dis Colon Rectum. 1990;33:684–7.

    Article  PubMed  CAS  Google Scholar 

  5. Harris MA, Ferrara A, Gallagher J, DeJesus S, Williamson P, Larach S. Stapled transanal rectal resection vs. transvaginal rectocele repair for treatment of obstructive defecation syndrome. Dis Colon Rectum. 2009;52:592–7.

    Article  PubMed  Google Scholar 

  6. Kahn MA, Stanton SL. Posterior colporrhaphy: its effects on bowel and sexual function. BJOG. 1997;104:82–6.

    Article  CAS  Google Scholar 

  7. Maher C, Baessler K, Glazener CM, Adams EJ, Hagen S. Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev. 2004;4:CD004014.

    PubMed  Google Scholar 

  8. Lamah M, Ho J, Leicester RJ. Results of anterior levatorplasty for rectocele. Colorectal Dis. 2001;3:412–6.

    Article  PubMed  CAS  Google Scholar 

  9. Montella JM, Morrill MY. Effectiveness of the McCall culdeplasty in maintaining support after vaginal hysterectomy. Int Urogynecol J Pelvic Floor Dysfunct. 2005;16:226–9.

    Article  PubMed  Google Scholar 

  10. Akladios CY, Dautun D, Saussine C, Baldauf JJ, Mathelin C, Wattiez A. Laparoscopic sacrocolpopexy for female genital organ prolapse: establishment of a learning curve. Eur J Obstet Gynecol Reprod Biol. 2010;149:218–21.

    Article  PubMed  Google Scholar 

  11. Sarles JC, Arnaud A, Selezneff I, Olivier S. Endo-rectal repair of rectocele. Int J Colorectal Dis. 1989;4:167–71.

    Article  PubMed  CAS  Google Scholar 

  12. Khubchandani IT, Sheets JA, Stasik JJ, Hakki AR. Endorectal repair of rectocele. Dis Colon Rectum. 1983;26:792–6.

    Article  PubMed  CAS  Google Scholar 

  13. Tjandra JJ, Ooi BS, Tang CL, Dwyer P, Carey M. Transanal repair of rectocele corrects obstructed defecation if it is not associated with anismus. Dis Colon Rectum. 1999;42:1554–50.

    Article  Google Scholar 

  14. Dippolito A, Esser S, Reed 3rd J. Anterior modification of Delorme procedure provides equivalent results to Delorme procedure in treatment of rectal outlet obstruction. Curr Surg. 2005;62:609–12.

    Article  PubMed  Google Scholar 

  15. Khubchandani IT, Clancy JP, Rosen L, Reither RD, Stasik JJ. Endorectal repair of rectocele revisited. Br J Surg. 1997;84:89–91.

    Article  PubMed  CAS  Google Scholar 

  16. Trompetto M, Clerico G, Realis Luc A, Marino F, Giani I, Ganio E. Transanal Delorme procedure for treatment of rectocele associated with rectal intussusception. Tech Coloproctol. 2006;10:389.

    Article  PubMed  CAS  Google Scholar 

  17. Block IR. Transrectal repair of rectocele using obliterative suture. Dis Colon Rectum. 1986;29:707–11.

    Article  PubMed  CAS  Google Scholar 

  18. Gagliardi G, Pescatori M, Altomare DF, Binda GA, Bottini C, Dodi G, et al. Italian Society of Colo-Rectal Surgery (SICCR): Results, outcome predictors, and complications after stapled transanal rectal resection for obstructed defecation. Dis Colon Rectum. 2008;51:186–95.

    Article  PubMed  Google Scholar 

  19. Pescatori M, Zbar AP. Reinterventions after complicated or failed STARR procedure. Int J Colorectal Dis. 2009;24:87–95.

    Article  PubMed  Google Scholar 

  20. Meurette G, Lehur PA. Commentary: STARR and Transtar procedures. Colorectal Dis. 2009;11:828–30.

    Article  PubMed  Google Scholar 

  21. Carriero A, Picchio M, Martellucci J, Talento P, Palimento D, Spaziani E. Laparoscopic correction of enterocele associated to stapled transanal rectal resection for obstructed defecation syndrome. Int J Colorectal Dis. 2010;25:381–7.

    Article  PubMed  Google Scholar 

  22. Leventoğlu S, Menteş BB, Akin M, Karen M, Karamercan A, Oğuz M. Transperineal rectocele repair with polyglycolic acid mesh: a case series. Dis Colon Rectum. 2007;50:2085–92.

    Article  PubMed  Google Scholar 

  23. Milito G, Cadeddu F, Grande M, Selvaggio I, Farinon AM. Advances in treatment of obstructed defecation: Biomesh transperineal repair. Dis Colon Rectum. 2009;52:2051.

    Article  PubMed  Google Scholar 

  24. D’Hoore A, Penninckx F. Laparoscopic ventral recto(colpo)pexy for rectal prolapse: surgical technique and outcome for 109 patients. Surg Endosc. 2006;20:1919–23.

    Article  PubMed  Google Scholar 

  25. D’Hoore A, Vanbeckevoort D, Penninckx F. Clinical, physiological and radiological assessment of rectovaginal septum reinforcement with mesh for complex rectocele. Br J Surg. 2008;95:1264–72.

    Article  PubMed  Google Scholar 

  26. Slawik S, Soulsby R, Carter H, Payne H, Dixon AR. Laparoscopic ventral rectopexy, posterior colporrhaphy and vaginal sacrocolpopexy for the treatment of recto-genital prolapse and mechanical outlet obstruction. Colorectal Dis. 2008;10:138–43.

    PubMed  CAS  Google Scholar 

  27. Watson SJ, Loder PB, Halligan S, Bartram CI, Kamm MA, Phillips 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.

    PubMed  CAS  Google Scholar 

  28. Halligan S, Bartram CI, Hall C, Wingate J. Enterocele revealed by simultaneous evacuation proctography and peritoneography: does defecation block exist? Am J Roetngenol. 1996;167:461–6.

    CAS  Google Scholar 

  29. Murthy VK, Orkin BA, Smith LE, Glassman LM. Excellent outcome using selective criteria for rectocele repair. Dis Colon Rectum. 1996;39:374–8.

    Article  PubMed  CAS  Google Scholar 

  30. Infantino A, Masin A, Melega E, Dodi G, Lise M. Does surgery resolve outlet obstruction. Int J Colorectal Dis. 1995;10:97–100.

    Article  PubMed  CAS  Google Scholar 

  31. Pescatori M, Milito G, Fiorino M, Cadeddu F. Complications and reinterventions after surgery for obstructed defecation. Int J Colorectal Dis. 2009;24:951–9.

    Article  PubMed  Google Scholar 

  32. Wong RK, Palsson OS, Turner MJ, Levy RL, Feld AD, von Korff M, et al. Inability of the Rome III criteria to distinguish functional constipation from constipation-subtype irritable bowel syndrome. Am J Gastroenterol. 2010;105:2228–34.

    Article  PubMed  Google Scholar 

  33. Suttor V, Prott GM, Hansen RD, Kellow JE, Malcolm A. Evidence for pelvic floor dyssynergia in patients with irritable bowel syndrome. Dis Colon Rectum. 2010;53:156–60.

    Article  PubMed  CAS  Google Scholar 

  34. Lehur PA, Stuto A, Fantoli M, Queralto M, Lazorthes F, Hershman M, ODS II Study Group. Outcomes of stapled transanal rectal resection vs. biofeedback for the treatment of outlet obstruction associated with rectal intussusception and rectocele: a multicenter, randomized, controlled trial. Dis Colon Rectum. 2008;51:1611–8.

    Article  PubMed  Google Scholar 

  35. Cundiff GW, Weidner AC, Visco AG, Addison WA, Bump RC. An anatomic and functional assessment of the discrete defect rectocele repair. Am J Obstet Gynecol. 1998;179:1451–7.

    Article  PubMed  CAS  Google Scholar 

  36. Mellgren A, Anzen B, Nilsson BY, Johansson C, Dolk A, Gillgren P, et al. Results of rectocele repair- a prospective study. Dis Colon Rectum. 1995;38:7–13.

    Article  PubMed  CAS  Google Scholar 

  37. Porter WE, Steele A, Walsh P, Kohli N, Karram MM. The anatomic and functional outcomes of defect-specific rectocele repairs. Am J Obstet Gynecol. 1999;181:1353–9.

    Article  PubMed  CAS  Google Scholar 

  38. Lopez A, Anzen B, Bremmer S, Mellgren A, Nilsson BY, Zetterström J, et al. Durability of success after rectocele repair. Int Urogynecol J. 2001;12:97–103.

    Article  CAS  Google Scholar 

  39. Smart NJ, Mercer-Jones MA. Functional outcome after transperineal rectocele Repair with porcine dermal collagen implant. Dis Colon Rectum. 2007;50:1422–7.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Piazza G Cesare 11, Bari, 70124, Italy

    Donato F. Altomare M.D.

  2. Department of General Surgery, University Hospital Tor Vergata, Rome, Italy

    Giovanni Milito M.D. & Federica Cadeddu M.D.

  3. Department of Medical and Surgical Critical Care, University of Florence, Viale Morgagni 85, Florence, 50124, Italy

    Filippo Pucciani M.D.

Authors
  1. Donato F. Altomare M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Giovanni Milito M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Federica Cadeddu M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Filippo Pucciani M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Donato F. Altomare M.D. .

Editor information

Editors and Affiliations

  1. Tamworth Rural Referral Hospital, Dean Street, Tamworth, 2340, New South Wales, Australia

    Andrew P. Zbar

  2. Delware Street 420, Minneapolis, 55455, Minnesota, USA

    Robert D. Madoff

  3. , Dept. Colorectal Surgery, Cleveland Clinic, Florida, Cleveland Clinic Blvd. 2950, Weston, 33331, Florida, USA

    Steven Wexner

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer-Verlag London

About this chapter

Cite this chapter

Altomare, D.F., Milito, G., Cadeddu, F., Pucciani, F. (2013). Failed Rectocele Repair. In: Zbar, A., Madoff, R., Wexner, S. (eds) Reconstructive Surgery of the Rectum, Anus and Perineum. Springer, London. https://doi.org/10.1007/978-1-84882-413-3_26

Download citation

  • DOI: https://doi.org/10.1007/978-1-84882-413-3_26

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-84882-412-6

  • Online ISBN: 978-1-84882-413-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation