Relationship between anatomic and symptomatic long-term results after rectocele repair for impaired defecation

PURPOSE: The aim of this study was to determine the long-term symptomatic a nd anatomic results of rectocele repair for impaired defecation. METHODS: A ll 26 females operated on during a five-year period in one hospital were re viewed in clinic. Follow-up was available on 22 patients after a median of 27 (range, 5-54) months. Interview, anorectal physiological testing, and ev acuation proctography were performed preoperatively and postoperatively. Fi fteen patients had a transperineal repair and seven patients had a transana l repair. RESULTS: Sixteen (73 percent) patients felt improved. A feeling o f incomplete emptying (19 vs. 10, preoperative vs. postoperative P = 0.02) and the need to use digital assistance vaginally (13 vs. 6; P = 0.07) were both reduced by surgery, the former being improved significantly more often after transperineal repair. The rectocele width and area were reduced by b oth types of surgery; however, the rectocele diameter was greater than 2 cm in 16 patients preoperatively and 10 patients postoperatively. There was n o significant difference between patients who did or did not feel improved by surgery in the percentage reduction in rectocele width (22 vs. 18 percen t; P = 0.95), the percentage reduction in rectocele area (65 vs. 62 percent ; P = 0.95), or a rectocele width of more than 2 cm (44 vs. 50 percent; P = 0.80), did vs. did not feel improved, respectively. CONCLUSION: Operative repair symptomatically improves a majority of patients with impaired defeca tion associated with a large rectocele, but the improvement probably relate s at least in part to factors other than the dimensions of the rectocele.