DOES SURGICAL REPAIR OF A RECTOCELE IMPROVE RECTAL EMPTYING

PURPOSE: This study was undertaken to assess results of surgical repai r of rectocele and to identify possible determinants of outcome from p atient's history and preoperative defecography. Another aim was to eva luate how surgery affects rectal evacuation. METHOD: Thirty-four women with constipation and rectal emptying difficulties underwent surgery with a transanal technique. A preoperative defecography was performed in each patient. They were followed up after a median of 10 (range, 2- 60) months with a questionnaire (n = 34) and a defecography (n = 31). Computer-based image analysis of defecographies was used to evaluate r ectal evacuation. RESULTS: In 27 patients 79 percent), the result of s urgery was good with subjectively improved emptying. The need for vagi nal or perineal digitation preoperatively was related to a good result (P < 0.05), whereas a previous hysterectomy (P < 0.01) and a large re ctal area on defecography) (P < 0.01) related to a poor result. Preope rative use of enemas, motor stimulants, or several types of laxatives also related to a poor outcome (P < 0.05). Surgical treatment resulted in reduction of the rectocele (P < 0.001), an elevated position of th e anorectal junction (P < 0.05), and improved rectal evacuation on def ecographies (P < 0.001). CONCLUSIONS: Surgical repair reduces the size of the rectocele and improves rectal emptying. These changes rue acco mpanied by a symptomatic improvement in the majority of patients. Preo perative patient data and defecography may help in selecting patients for surgery.