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Transanal repair of rectocele corrects obstructed defecation if it is not associated with anismus

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Diseases of the Colon & Rectum

Abstract

PURPOSE: Rectocele is often associated with anorectal symptoms. Various surgical techniques have been described to repair the rectocele. The surgical results are variable. This study evaluated the results of transanal repair of rectocele, with particular emphasis on the impact of concomitant anismus on postoperative functional outcome. METHODS: Fifty-nine consecutive females who underwent transanal repair of rectocele for obstructed defecation were prospectively reviewed. All 59 patients were parous with a median parity of 2 (range, 1–6) and a median age of 58 (range, 46–68) years. The median length of follow-up was 19 (range, 6–40) months. Anismus was detected by anorectal physiology and defecography. The functional outcome was assessed by a standard questionnaire, physical examination, anorectal manometry, neurophysiology, and defecography. The quality-of-life index was obtained using a visual analog scale (from 1–10, with 10 being the best). RESULTS: The functional outcome of transanal repair of rectocele was superior in patients without anismus. Forty (93 percent) of the 43 patients without anismus showed improved evacuation after repair compared with 6 (38 percent) of the 16 patients with anismus (P<0.05). The quality-of-life index improved (9vs. 4) if anismus was not present (P<0.05). There were minimal complications. Hemorrhage requiring blood transfusion (2 units) occurred in one patient and urinary retention in another. CONCLUSION: Transanal repair of rectocele is safe and, in the absence of anismus, effectively corrects obstructed defecation.

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References

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

    Google Scholar 

  2. Nichols DH, Randall CL. Vaginal surgery. 2nd ed. Baltimore: Williams & Wilkins, 1983.

    Google Scholar 

  3. Richardson AC. The rectovaginal septum revisited: its relationship to rectocele and its importance in rectocele repair. Clin Obstet Gynecol 1993;36:976–83.

    Google Scholar 

  4. 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 

  5. Marks MM. The rectal side of the rectocele. Dis Colon Rectum 1967;10:387–8.

    Google Scholar 

  6. Pitchford CA. Rectocele: a cause of anorectal pathologic changes in women. Dis Colon Rectum 1967;10:464–6.

    Google Scholar 

  7. Redding MD. The relaxed perineum and anorectal disease. Dis Colon Rectum 1965;8:279–82.

    Google Scholar 

  8. Bartolo DC, Roe AM, Virjee J, Mortensen NJ, Locke-Edmunds JC. An analysis of rectal morphology in obstructed defaecation. Int J Colorectal Dis 1988;3:17–22.

    Google Scholar 

  9. Goei R, van Engelshoven J, Schouten H, Baeten C, Stassen C. Anorectal function: defecographic measurements in asymptomatic subjects. Radiology 1989;173:137–41.

    Google Scholar 

  10. Goei R. Anorectal function in patients with defecation disorders and asymptomatic subjects: evaluation with defecography. Radiology 1990;174:121–3.

    Google Scholar 

  11. 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 

  12. Turnbull GK, Bartram CI, Lennard-Jones JE. Radiologic studies of rectal evacuation in adults with idiopathic constipation. Dis Colon Rectum 1988;31:190–7.

    Google Scholar 

  13. Capps WF Jr. Rectoplasty and perineoplasty for the symptomatic rectocele: a report of fifty cases. Dis Colon Rectum 1975;18:237–44.

    Google Scholar 

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

    Google Scholar 

  15. 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 

  16. Mellgren A, Anzen B, Nilsson BY,et al. Results of rectocele repair: a prospective study. Dis Colon Rectum 1995;38:7–13.

    Google Scholar 

  17. 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 

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

    Google Scholar 

  19. Karlbom U, Graf W, Nilsson S, Påhlman L. Does surgical repair of a rectocele improve rectal emptying? Dis Colon Rectum 1996;39:1296–1302.

    Google Scholar 

  20. Rao GN, Carr ND. Endorectal repair of rectocele revisited [letter]. Br J Surg 1997;84:1034.

    Google Scholar 

  21. Khubchandani IT, Claney JP III, Rosen L, Riether RD, Stasik JJ Jr. Endorectal repair of rectocele revisited. Br J Surg 1997;84:89–91.

    Google Scholar 

  22. Parker MC, Phillips RK. Repair of rectocele using Marlex mesh. Ann R Coll Surg Engl 1993;75:193–4.

    Google Scholar 

  23. 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 

  24. Lyon TL, Winer WK. Laparoscopic rectocele repair using polyglactin mesh. J Am Assoc Gynecol Laparosc 1997;4:381–4.

    Google Scholar 

  25. 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 

  26. Miller R, Duthie GS. Bartolo DC, Roe AM, Locke-Edmunds J, McMortensen NJ. Anismus in patients with normal and slow transit constipation. Br J Surg 1991;78:690–2.

    Google Scholar 

  27. 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 

  28. Siproudhis L, Dautreme S, Ropert A,et al. Dyschezia and rectocele—a marriage of convenience? Dis Colon Rectum 1993;36:1030–6.

    Google Scholar 

  29. Mellgren A, Bremmer S, Johansson C,et al. Defecography: results of investigations in 2816 patients. Dis Colon Rectum 1994;37:1133–41.

    Google Scholar 

  30. Wexner SD, Cheape JD, Jorge JM, Heymen S, Jagelman DG. Prospective assessment of biofeedback for the treatment of paradoxical puborectalis syndrome. Dis Colon Rectum 1992;35:145–50.

    Google Scholar 

  31. Jorge JM, Wexner SD. Anorectal manometry: techniques and clinical applications. South Med J 1993;86:924–31.

    Google Scholar 

  32. Sorensen M, Tetzchner T, Rasmussen OO, Christiansen J. Relation between electromyography and anal manometry of the external anal sphincter. Gut 1991;32:1031–4.

    Google Scholar 

  33. Whitehead WE, Schuster MM. Anorectal physiology and pathophysiology. Am J Gastroenterol 1987;82:487–97.

    Google Scholar 

  34. Broden B, Snellman B. Procidentia of the rectum studied with cineradiography: a contribution to the discussion of causative mechanism. Dis Colon Rectum 1968;11:330–47.

    Google Scholar 

  35. Halligan S, Bartram CI, Park HJ, Kamn MA. Proctographic features of anismus. Radiology 1995;197:679–82.

    Google Scholar 

  36. Hinton JM, Lennard-Jones JE, Young AC. A new method for studying gut transit times using radio-opaque markers. Gut 1969;10:842–7.

    Google Scholar 

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

    Google Scholar 

  38. Agachan F, Pfeifer J, Wexner SD. Defecography and proctography: results of 744 patients. Dis Colon Rectum 1996;39:899–905.

    Google Scholar 

  39. Delemarre JB, Kruyt RH, Doornbos J,et al. Anterior rectocele: assessment with radiographic defecography, dynamic magnetic resonance imaging and physical examination. Dis Colon Rectum 1994;37:249–59.

    Google Scholar 

  40. 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 

  41. Ho YH, Ang M, Nyam D, Tan M, Seow-Choen F. Transanal approach to rectocele repair may compromise anal sphincter pressures. Dis Colon Rectum 1998;41:354–8.

    Google Scholar 

  42. Mollen RM, van Laarhoven CJ, Kuijpers JH. Pathogenesis and management of rectoceles. Semin Colon Rectal Surg 1996;7:192–6.

    Google Scholar 

  43. Smith AN, Varma JS, Binnie NR, Papachrysostomou M. Disordered colorectal motility in intractable constipation following hysterectomy. Br J Surg 1990;77:1361–6.

    Google Scholar 

  44. Halligan S, Bartram CI. Is barium trapping in rectoceles significant? Dis Colon Rectum 1995;38:764–8.

    Google Scholar 

  45. Barnes PR, Lennard-Jones JE. Function of the striated anal sphincter during straining in control subjects and constipated patients with a radiologically normal rectum or idiopathic megacolon. Int J Colorectal Dis 1988;3:207–9.

    Google Scholar 

  46. Johansson C, Nilsson BY, Mellgren A, Dolk A, Holmström B. Paradoxical sphincter reaction and associated colorectal disorders. Int J Colorectal Dis 1992;7:89–94.

    Google Scholar 

  47. Preston DM, Lennard-Jones JL. Anismus in chronic constipation. Dig Dis Sci 1985;30:413–8.

    Google Scholar 

  48. Jorge JM, Wexner SD, Ger GC, Salanga VD, Nogueras JJ, Jagelman DG. Cinedefecography and electromyography in the diagnosis of nonrelaxing puborectalis syndrome. Dis Colon Rectum 1993;36:668–76.

    Google Scholar 

  49. Kuijpers HC, Bleijenberg G. The spastic pelvic floor syndrome: a cause of constipation. Dis Colon Rectum 1985;28:669–72.

    Google Scholar 

  50. Kerremans R. Radio-cinematographic examination of the rectum and the anal canal in cases of rectal constipation: a radio-cinematographic and physical explanation of dyschezia. Acta Gastroenterol Belg 1968;31:561–70.

    Google Scholar 

  51. Johansson C, Nilsson BY, Holmström B, Dolk A. Is paradoxical sphincter reaction provoked by needle electrode electromyography? Dis Colon Rectum 1991;34:1109–12.

    Google Scholar 

  52. Sarles JC, Arnaud A, Sielezneff I, Olvier S. Endorectal repair of rectocele. Int J Colorectal Dis 1989;4:167–71.

    Google Scholar 

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Authors and Affiliations

  1. From the Department of Surgery, Colorectal Unit, University of Melbourne, The Royal Melbourne Hospital, Australia

    Joe J. Tjandra M.D. (F.R.A.C.S.), Boon-Swee Ooi (F.R.C.S.) & Choong-Leong Tang (F.R.C.S.)

  2. The Royal Women's Hospital, Melbourne, Victoria, Australia

    Peter Dwyer (F.R.A.C.O.G.) & Marcus Carey (F.R.A.C.O.G.)

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  1. Joe J. Tjandra M.D.
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  2. Boon-Swee Ooi
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  3. Choong-Leong Tang
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  4. Peter Dwyer
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  5. Marcus Carey
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Supported in part by the Stewardson Charitable Trusts.

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Tjandra, J.J., Ooi, BS., Tang, CL. et al. Transanal repair of rectocele corrects obstructed defecation if it is not associated with anismus. Dis Colon Rectum 42, 1544–1550 (1999). https://doi.org/10.1007/BF02236204

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