Transanal rectocele repair: Excellent intermediate outcome

OBJECTIVE: The objective of this study was to assess the intermediate-term outcome of transanal rectocele repair in a cohort of patients selected for treatment based on specific selective criteria. STUDY DESIGN: A retrospective chart review of 74 patients who underwent a rectocele repair by one surgeon between 1991 and 2004 was performed. Fifty-one patients underwent a transanal rectocele repair and form the cohort of this study. RESULTS: The mean age was 62 years (range, 32-87 years); all were female. Seven patients had less than 3 months of follow up and were not included in the outcome analysis, leaving 44 for review. Mean follow up was 3.7 years (range, 3 months to 13.3 years). Only one (2%) patient had a major complication, a rectoperineal body fistula through a concomitantly performed sphincteroplasty. Forty (91%) patients had resolution of their rectocele-related symptoms and had no evidence of recurrence on follow up. Recurrent rectoceles were identified in 4 (9%) patients, only one of whom had worsening symptoms. Criteria for repair included symptoms of pelvic outlet obstruction, the sensation of a vaginal mass or bulge that required digital support, retention of barium on defecography, and/or a very large rectocele. There was no difference in any of these indications comparing recurrence versus no recurrence except for the presence of a very large rectocele, which paradoxically was not present in any patient that recurred (0% vs. 65%). There was also no difference in the performance of additional procedures such as enterocele or cystocele repair between groups. There did not seem to be degradation in results over time comparing early and late symptomatic relief. CONCLUSIONS: Rectoceles transanally repaired for specific selective criteria may be expected to have excellent outcome in the majority of cases with low morbidity and sustained relief of symptoms.