RESULTS OF TRANSPERINEAL LEVATORPLASTY IN THE TREATMENT OF SYMPTOMATIC RECTOCELE

A rectocele is a herniation of the anterior rectal wall through the re ctovaginal septum into the vagina. The most important risk factors are a previous hysterectomy, obstetic injuries and the descending perineu m syndrome. In some patients the rectocele becomes symptomatical becau se of defecation disorders. The patients have to give manual vaginal o r perineal help during defecation. Radiological parameters like the si ze of the rectocele or retention of barium only have limited value for the clinical evaluation. In a high percentage we find simultaneous sy mptoms of fecal incontinence. Transperineal anterior levatorplasty mak es it possible to close the rectocele. This procedure has a positive i nfluence on defecation and continence. In a prospective study we perfo rmed anterior levatorplasty in 35 female patients having a rectocele i n combination with rectal outlet obstruction. Subjective improvement o f the defecation disorder was found in 74%. Only 1 patient complained of deterioration. No patient needed manual vaginal help postoperativel y. Patients who needed perineal help preoperatively had worse results. Patients who did not need any manual help preoperatively nevertheless reported an improvement postoperatively. Fifteen of 20 patients, who suffered from fecal incontinence preoperatively, reported a better con tinence postoperatively (75%). Even in patients with incontinence the anterior levatorplasty is a good method for rectocele repair, as it im proves rectal emptying and simultaneously provides therapy for fecal i ncontinence.