RESULTS OF RECTOCELE REPAIR - A PROSPECTIVE-STUDY

PURPOSE: This study was designed to evaluate the results of rectocele repair and parameters that might be useful in selecting patients for t his operation. METHODS: Twenty-five patients with symptom-giving recto celes were prospectively evaluated with a standardized questionnaire, physical examination, defecography, colon transit studies, anorectal m anometry, and electrophysiology. Patients underwent posterior colporrh aphy and perineorrhaphy. They were followed postoperatively (mean, 1.0 year) with the same questionnaire, physical examination, defecography , anorectal manometry, and electrophysiology. RESULTS: Constipation ha d improved postoperatively in 21 of 24 constipated patients (88 percen t). At postoperative follow-up 13 patients (52 percent) had no constip ation symptoms, 8 (32 percent) had occasional symptoms, and 4 (16 perc ent) had symptoms more than once per week. Four patients with rectocel e at preoperative defecography, but not at physical examination, had f avorable outcomes following surgery. The majority of patients not usin g vaginal digitalization preoperatively had improved with respect to c onstipation. AU patients with pathologic transit studies had various d egrees of constipation postoperatively. Constipation was not improved in two of five patients with preoperative paradoxic sphincter reaction . CONCLUSIONS: Rectocele is one cause of constipation that can be trea ted with good results. Preoperative use of vaginal digitalization is n ot mandatory for a good postoperative result. Defecography is an impor tant complement to physical examination. Patients with pathologic tran sit study might have a less favorable outcome of rectocele repair with respect to constipation. More studies about the significance of parad oxic sphincter reaction in these patients are indicated.