Functional Disorders: Rectocele

ABSTRACT

The baseline prevalence of rectocele is not well defined as many women are asymptomatic and do not seek medical help. Gynecologists tend to perform posterior wall repairs more commonly than colorectal surgeons because they also address patients with vaginal symptoms in addition to those with defecatory dysfunction. Overall, surgical correction success rates for rectocele correction are quite high when using a vaginal approach. Vaginal dissection, as opposed to transrectal or transperineal approaches, results in better visualization and access to the endopelvic fascia and levator musculature, allowing for more firm anatomic correction. In addition, the maintenance of rectal mucosal integrity may reduce the risk of postoperative complications such as infection and fistula formation. With the rapidly growing popularity of synthetic and biologic implant kits in the field of pelvic reconstruction, outcomes data reporting is increasing and allowing surgeons to better understand the effect of various surgical techniques on vaginal, sexual, and defecatory symptoms.

Rectocele - posterior colporrhaphy - site-specific defect rectocele repair - dyspareunia - defecation disorders

REFERENCES

• 1 Fenner D E. Diagnosis and assessment of sigmoidoceles.  Am J Obstet Gynecol. 1996;  175 1438-1442
• 2 Altman D, Lopez A, Kierkegaard J et al.. Assessment of posterior vaginal wall prolapse: comparison of physical findings to cystodefecoperitoneography.  Int Urogynecol J Pelvic Floor Disfunct. 2005;  16 96-103
• 3 Brubaker L. Rectocele.  Curr Opin Obstet Gynecol. 1996;  8 376-379
• 4 Kahn M A, Stanton S L. Techniques of rectocele repair and their effects of bowel function.  Int Urogynecol J. 1998;  9 37-47
• 5 Delancey J OL, Hurd W W. Size of the urogenital hiatus in the levator ani muscles in normal women and women with pelvic organ prolapse.  Obstet Gynecol. 1998;  91 364-368
• 6 Richardson A C. The rectovaginal septum revisited: its relationship to rectocele and its importance in rectocele repair.  Clin Obstet Gynecol. 1993;  36 976-983
• 7 Uhlenhuth E, Wolfe W M, Smith E M, Middleton E B. The rectogenital septum.  Surg Gynecol Obstet. 1948;  86 148-163
• 8 Milley P S, Nichols D H. A correlative investigation of the human rectovaginal septum.  Anat Rec. 1969;  163 443-452
• 9 Delancey J OL. Anatomic aspects of vaginal eversion after hysterectomy.  Am J Obstet Gynecol. 1992;  166 1717-1724
• 10 Mizrahi N, Kapoor D, Nogueras J J, Weiss E D, Wexner S D, Davila G W. A gynecologic perspective of posterior compartment defects.  Colorect Dis. 2002;  4(suppl) H68
• 11 Davila G W, Ghoniem G M, Kapoor D S, Contreras-Ortiz O. Pelvic floor dysfunction management practice patterns: a survey of members of the international urogynecological association.  Int Urogynecol J. 2002;  13 319-325
• 12 Guerette N, Davila G W. Can discrete vaginal fascial defects be accurately identified preoperatively?.  Neurourol Urodyn. 2004;  23(5/6) 436-437
• 13 Marks M M. The rectal side of the rectocele.  Dis Colon Rectum. 1967;  10 387-388
• 14 Khubchandani I T, Clancy J P, Rosen L, Riether R D, Stasik J J. Endorectal repair of rectocele revisited.  Br J Surg. 1997;  84(1) 89-91
• 15 Ho Y H, Ang M, Nyam D, Tan M, Seow-Choen F. Transanal approach to rectocele repair may compromise anal sphincter pressures.  Dis Colon Rectum. 1998;  41 354-358
• 16 Tjandra J J, Ooi B S, Tang C L, Dwyer P, Carey M. Transanal repair of rectocele corrects obstructed defecation if it is not associated with anismus.  Dis Colon Rectum. 1999;  42 1544-1550
• 17 Goh J TW, Tjandra J J, Carey M P. How could management of rectoceles be optimized?.  ANZ J Surg. 2002;  72 896-901
• 18 Paraiso M FR, Falcone T, Walters M D. Laparoscopic surgery for enterocele, vaginal apex prolapse and rectocele.  Int Urogynecol J. 1999;  10 223-229
• 19 Nichols D H. Posterior colporrhaphy and perineorrhaphy: separate and distinct operations.  Am J Obstet Gynecol. 1991;  164 714-721
• 20 Paraiso M F, Weber A M, Walters M D, Ballard L A, Piedmonte M R, Skibinski C. Anatomic and functional outcome after posterior colporrhaphy.  J Pelvic Surg. 2001;  7 335-339
• 21 Mellgren A, Anzen B, Nilsson B Y et al.. Results of rectocele repair; a prospective study.  Dis Colon Rectum. 1995;  38 7-13
• 22 Kahn M A, Stanton S L. Posterior colporrhaphy: its effects on bowel and sexual function.  Br J Obstet Gynaecol. 1997;  104 82-86
• 23 Lopez A, Anzen B, Bremmer S et al.. Durability of success after rectocele repair.  Int Urogynecol J. 2001;  12 97-103
• 24 Francis W J, Jeffcoate T N. Dyspareunia following vaginal operations.  J Obstet Gynaecol Br Emp. 1961;  68 1-10
• 25 Cundiff G W, Weidner A C, Visco A G, Addison W A, Bump R C. An anatomic and functional assessment of the discrete defect rectocele repair.  Am J Obstet Gynecol. 1998;  179 1451-1457
• 26 Glavind K, Madsen H. A prospective study of the discrete fascial defect rectocele repair.  Acta Obstet Gynecol Scand. 2000;  79 145-147
• 27 Kenton K, Shott S, Brubaker L. Outcome after rectovaginal reattachment for rectocele repair.  Am J Obstet Gynecol. 1999;  181 1360-1363
• 28 Porter W E, Steele A, Walsh P, Kohli N, Karram M M. The anatomic and functional outcomes of defect-specific rectocele repairs.  Am J Obstet Gynecol. 1999;  181 1353-1358
• 29 Paraiso M FR, Barber M D, Muir T W, Walters M D. Rectocele repair: a randomized trial of three surgical techniques including graft augmentation.  Am J Obstet Gynecol. 2006;  195 1762-1771
• 30 Sand P K, Abramov Y, Gandhi S, Goldberg R P, Botros S M, Kwon C. Site-specific rectocele repair compared with standard posterior colporrhaphy.  Obstet Gynecol. 2005;  105 314-318
• 31 Boccasanta P, Venturi M, Stuto A, Corrado B. Stapled transanal rectal resection for outlet obstruction:a prospective multicenter trial.  Dis Colon Rectum. 2004;  47 1285-1297
• 32 Boccasanta P, Venturi M, Salamina G, Cesana B M. New trends in the surgical treatment of outlet obstruction: clinical and functional results of two novel transanal stapled techniques from a randomized controlled trial.  Int J Colorectal Dis. 2004;  19 359-369
• 33 Arnold M W, Stewart W RC, Aguilar P S. Rectocele: four years' experience.  Dis Colon Rectum. 1990;  33 684-687
• 34 Iglesia C B, Fenner D E, Brubaker L. The use of mesh in gynecologic surgery.  Int Urogynecol J. 1997;  8 105-115
• 35 Sand P K, Koduri S, Lobel R W. Prospective randomized trial of polyglactin 910 mesh to prevent recurrences of cystoceles and rectoceles.  Am J Obstet Gynecol. 2001;  184 1357-1364
• 36 De Tayrac R, Picone O, Chauveaud-Lambling A, Fernandez H. A 2-year anatomical and functional assessment of transvaginal rectocele repair using a polypropylene mesh.  Int Urogynecol J. 2006;  17 100-105
• 37 Kohli N, Miklos J R. Dermal graft-augmented rectocele repair.  Int Urogynecol J. 2003;  14 146-149
• 38 Dell J R, O'Kelley K R. Pelvisoft biomesh augmentation of rectocele repair:the initial clinical experience in 35 patients.  Int Urogynecol J. 2005;  16 44-47
• 39 Lyons T L, Winer W K. Laparoscopic rectocele repair using polyglactin mesh.  J Am Assoc Gynecol Laparosc. 1997;  4 381-384