TRANSANAL APPROACH TO RECTOCELE REPAIR MAY COMPROMISE ANAL-SPHINCTER PRESSURES

PURPOSE: This study prospectively assessed the functional results, par ticularly anal sphincter impairment, following transanal repair of rec tocele for chronic intractable constipation. METHOD: Twenty-one consec utive women (mean age, 47.7 (standard error of the mean, 2.7) years) h ad the diagnosis of rectocele obstructing defecation made on synchroni zed anal manometry, electromyography, and cinedefecography. All underw ent a standardized transanal repair with controlled anal stretching (m aximum of 4 cm) from self-retaining anal retractors. The clinical func tion and anorectal manometry were assessed before surgery and were rep eated six months later. RESULTS: All 21 patients were subjectively sat isfied with the relief from constipation after surgery. There were sig nificant. improvements in the straining at defecation (before, n = 19; after, n = 3; P = 0.001), need to digitate per vagina (before, n = 16 ; after, n = 0; P = 0.001), stool frequency (before, 3.8 (0.7) times w eekly; after, 8.6 (1.2); P = 0.004), and laxative requirements (be for e, n = 7; after, n = 0; P = 0.03). Although none were clinically incon tinent, there was a mean 28 mmHg impairment in resting (P < 0.05) and 42.6 mmHg impairment in maximum squeeze anal pressures (P < 0.05) afte r operations. There was no other morbidity. CONCLUSION: Transanal rect ocele repair effectively improves constipation problems, at the risk o f impaired anal sphincter function. Although clinical incontinence was minimum, an alternative approach to rectocele repair should be consid ered when anal sphincters are lax.