The anatomic and functional outcomes of defect-specific rectocele repairs

OBJECTIVE: This study was undertaken to evaluate the anatomic, functional, and quality-of-life effects of site-specific posterior colporrhaphy in the surgical management of rectocele. STUDY DESIGN: In a retrospective observational study 125 patients were stud ied who had undergone site-specific posterior colporrhaphy between 1995 and 1996, either alone or in conjunction with other pelvic procedures. Physica l examination was performed greater than or equal to 6 months after the ope ration to assess the anatomic success of the repair. Standardized questionn aires were used to assess duality of life, sexual function, and bowel funct ion. RESULTS: Surgical correction was found at follow-up examination to have bee n achieved in 82% of eligible patients (73/89). All daily aspects of living improved significantly (P < .05), including ability to do housework (56% i mprovement or cure), travel (58% improvement or cure), and social activitie s (60% improvement or cure). Emotional well-being also significantly improv ed after the operation, as measured by thoughts of embarrassment (57% impro vement or cure) or frustration (71% improvement or cure). Sexual function w as not affected; however, reports of dyspareunia significantly (P < .04) im proved or were cured after the operation in 73% of patients (19/26), worsen ed in 19% of patients (5/26), and arose de novo in 3 patients. Results show ed no other significant differences in vaginal dryness, orgasm ability, sex ual desire, sexual frequency, or sexual satisfaction. Bowel symptoms were a ssessed subjectively and were noted to have significantly improved (P < .00 8) after the operation. The following improvement or cure rates were obtain ed: stooling difficulties, 55%; pelvic pain or pressure, 73%; vaginal mass, 74%; and splinting, 65%. CONCLUSION: This study indicates that defect-specific posterior colporrhaph y is equal to or superior to traditional posterior colporrhaphy. This type of repair provides durable anatomic support and is successful in restoring bowel function. It does not detrimentally affect sexual function, may aid i n the resumption of sexual activity, and significantly improves quality of life and social aspects of daily living.