Relationship between anatomic and symptomatic long-term results after rectocele repair for impaired defecation (original) (raw)

Abstract

PURPOSE: The aim of this study was to determine the long-term symptomatic and anatomic results of rectocele repair for impaired defecation. METHODS: All 26 females operated on during a five-year period in one hospital were reviewed in clinic. Follow-up was available on 22 patients after a median of 27 (range, 5–54) months. Interview, anorectal physiological testing, and evacuation proctography were performed preoperatively and postoperatively. Fifteen patients had a transperineal repair and seven patients had a transanal repair. RESULTS: Sixteen (73 percent) patients felt improved. A feeling of 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 both types of surgery; however, the rectocele diameter was greater than 2 cm in 16 patients preoperatively and 10 patients postoperatively. There was no significant difference between patients who did or did not feel improved by surgery in the percentage reduction in rectocele width (22_vs. 18 percent;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 defecation associated with a large rectocele, but the improvement probably relates at least in part to factors other than the dimensions of the rectocele.

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Authors and Affiliations

  1. From the Physiology Unit, St. Mark's Hospital, London, United Kingdom
    C. J. H. M. Van Laarhoven M.D. & M. A. Kamm M.D.
  2. the Department of Surgery, St. Mark's Hospital, London, United Kingdom
    P. R. Hawley (F.R.C.S.) & R. K. S. Phillips (F.R.C.S.)
  3. the Department of Radiology, St. Mark's Hospital, London, United Kingdom
    C. I. Bartram (F.R.C.R.) & S. Halligan M.D.

Authors

  1. C. J. H. M. Van Laarhoven M.D.
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  2. M. A. Kamm M.D.
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  3. C. I. Bartram
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  4. S. Halligan M.D.
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  5. P. R. Hawley
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  6. R. K. S. Phillips
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Van Laarhoven, C.J.H.M., Kamm, M.A., Bartram, C.I. et al. Relationship between anatomic and symptomatic long-term results after rectocele repair for impaired defecation.Dis Colon Rectum 42, 204–210 (1999). https://doi.org/10.1007/BF02237129

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