An anatomic and functional assessment of the discrete defect rectocele repair

• Published in: American journal of obstetrics and gynecology 1998-12, Vol.179 (6), p.1451-1457
• Main Authors: Cundiff, Geoffrey W., Weidner, Alison C., Visco, Anthony G., Addison, W.Allen, Bump, Richard C.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Constipation - etiology; Fecal Incontinence - etiology; Female; Follow-Up Studies; Gynecologic Surgical Procedures - methods; Humans; Middle Aged; Patient Satisfaction; Perineal descent; perineorrhaphy; posterior colporrhaphy; posterior repair; Rectocele - classification; Rectocele - complications; Rectocele - surgery; rectocele repair; Severity of Illness Index; Sexual Dysfunction, Physiological - etiology; Treatment Outcome; Vagina - surgery
• ISSN: 0002-9378
• DOI: 10.1016/S0002-9378(98)70009-2

Objective: The aim of this study was to describe the anatomic and functional results of the discrete fascial defect rectocele repair. Study Design: Sixty-nine women underwent rectocele repair at Duke University Medical Center during a 3-year period beginning January 1, 1994. Repair was limited to reapproximation of discrete defects in the rectovaginal fascia, without levator plication or perineorrhaphy. Outcome measures included Pelvic Organ Prolapse Quantitation measurements, prolapse stage, and a symptom questionnaire. Univariate and nonparametric tests were used as appropriate. Results: Before the operation 46% patients (32/69) reported constipation, 39% (27/69) reported splinting, 32% (22/69) reported tenesmus, and 13% (9/69) reported fecal incontinence. The median preoperative posterior Pelvic Organ Prolapse Quantitation stage was 2 (1-4). Pelvic Organ Prolapse Quantitation stage had improved for all but 2 women at 6 weeks. Eighteen percent (8/43) had recurrent rectoceles at 12 months. Mean values for the points describing the posterior vaginal wall improved >2 cm ( P < .0001). Although perineorrhaphy was not performed, the genital hiatus decreased by 2.3 cm ( P < .0001), with no significant change in the length of the perineal body. Functional results mirrored anatomic results, with statistically significant improvements for all symptoms. Conclusions: The discrete defect rectocele repair provides anatomic correction of rectoceles with alleviation of associated symptoms for most women. (Am J Obstet Gynecol 1998;179:1451-7.)