An anatomic and functional assessment of the discrete defect rectocele repair

OBJECTIVE: The aim of this study was to describe the anatomic and functiona l results of the discrete fascial defect rectocele repair. STUDY DESIGN: Sixty-nine women underwent rectocele repair at Duke Universit y Medical Center during a 3-year period beginning January 1, 1994. Repair w as limited to reapproximation of discrete defects in the rectovaginal fasci a, without levator plication or perineorrhaphy. Outcome measures included P elvic Organ Prolapse Quantitation measurements, prolapse stage, and a sympt om questionnaire. Univariate and nonparametric tests were used as appropria te. RESULTS: Before the operation 46% patients (32/69) reported constipation, 3 9% (27/69) reported splinting, 32% (22/69) reported tenesmus, and 13% (9/69 ) reported fecal incontinence. The median preoperative posterior Pelvic Org an Prolapse Quantitation stage was 2 (1-4). Pelvic Organ Prolapse Quantitat ion 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 descr ibing the posterior Vaginal wall improved >2 cm (P <.0001). Although perine orrhaphy was not performed, the genital hiatus decreased by 2.3 cm (P <.000 1), with no significant change in the length of the perineal body. Function al results mirrored anatomic results, with statistically significant improv ements for all symptoms. CONCLUSIONS: The discrete defect rectocele repair provides anatomic correct ion of rectoceles with alleviation of associated symptoms for most women.