Specific Changes in Manometric Parameters are Associated with Non-improvement in Symptoms after Rectocele Repair.

INTRODUCTION AND HYPOTHESIS: The present study aimed to assess the changes in manometric parameters after transperineal repair (TPR) of rectocele and interpret failure of symptom improvement in light of these changes. METHODS: This was an observational cohort study on patients with anterior rectocele who underwent TPR in the period of February 2016 to February 2019. Data collected included patients' demographics, rectocele size, Wexner constipation and incontinence scores, anal pressures, and rectal sensation before and 12 months after TPR. Analysis of data was done by paired t-test and chi-square test. RESULTS: Forty-six female patients with a mean age of 43.2 ± 10.7 years were included. After a mean follow-up of 13.9 ± 2.7 months, 30 (65.2%) patients reported clinical improvement and 16 (34.8%) had no significant improvement. At 12 months after rectocele repair, the entire cohort studied showed an insignificant increase in the mean anal pressures and a significant decrease in the thresholds of first rectal sensation, first urge, intense urge, and maximum tolerable volume (MTV). Patients who clinically improved showed similar physiologic changes to the entire cohort examined, whereas patients who had no clinical improvement showed significant increases in the mean anal pressures and insignificant decreases in rectal sensation and MTV. CONCLUSION: Patients who showed clinical improvement showed insignificant increases in anal pressures and significant decreases in thresholds of first rectal sensation, first urge, intense urge, and MTV. Contrarily, patients who did not show clinical improvement showed significant increases in anal pressures and insignificant reduction in sensory thresholds.

Functional Outcome and Sexual-Related Quality of Life After Transperineal Versus Transvaginal Repair of Anterior Rectocele: A Randomized Clinical Trial.

BACKGROUND: Methods of treatment of rectocele include transperineal, transvaginal, and transanal approaches and ventral rectopexy. OBJECTIVE: The present randomized study aimed to compare the outcome of transperineal repair and transvaginal repair of anterior rectocele. DESIGN: This is a randomized, single-blinded clinical trial. SETTING: This study was conducted at the Colorectal Surgery Unit, Mansoura University Hospitals. PATIENTS: Adult female patients with anterior rectocele reporting obstructed defecation syndrome were selected. INTERVENTIONS: Anterior rectocele was surgically treated via a transperineal or transvaginal approach. MAIN OUTCOME MEASURES: Improvement in constipation, operation time, hospital stay, complications, changes in anal pressures, and improvement in sexual-related quality of life was assessed by use of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire, and the incidence of dyspareunia postoperatively was assessed. RESULTS: Sixty-four female patients of a mean age of 43.5 years were entered into the trial. There was no significant difference between the 2 groups regarding the operation time. Patients undergoing transperineal repair had significantly longer hospital stays than those undergoing transvaginal repair (2.4 vs 2.1 days, p = 0.03). There was no significant difference between the 2 groups regarding postoperative complications and recurrence of rectocele. Significant decrease in the constipation scores was recorded in both groups at 6 and 12 months after surgery. The decrease in the constipation scores after transvaginal repair was significantly higher than after transperineal repair at 6 and 12 months postoperatively. Although resting and squeeze anal pressures were significantly increased at 12 months after transperineal repair, they did not show significant change after transvaginal repair. Improvement in sexual-related quality of life was significantly higher in the transvaginal repair group than in the transperineal repair group at 6 and 12 months after surgery. Dyspareunia improved after transvaginal repair and worsened after transperineal repair, yet this change was insignificant. LIMITATIONS: This was a single-center study comprising a relatively small number of patients. CONCLUSION: Transvaginal repair of rectocele achieved better improvement in constipation and sexual-related quality of life than transperineal repair. Changes in dyspareunia after both techniques were not significant. See Video Abstract at http://links.lww.com/DCR/B148. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03801291. RESULTADO FUNCIONAL Y CALIDAD DE VIDA RELACIONADA CON EL SEXO DESPUÉS DE LA REPARACIÓN TRANSPERINEAL VERSUS TRANSVAGINAL DEL RECTOCELE ANTERIOR: UN ENSAYO CLÍNICO ALEATORIZADO: Los métodos de tratamiento del rectocele incluyen los abordajes transperineal, transvaginal y transanal y la rectopexia ventral.El objetivo del presente estudio aleatorizado fue comparar el resultado de la reparación transperineal y la reparación transvaginal del rectocele anterior.Ensayo clínico aleatorizado, simple ciego.Unidad de Cirugía Colorrectal, Hospital Universitario de Mansoura.Pacientes mujeres adultas con rectocele anterior que se quejan de síndrome de defecación obstruida.Tratamiento quirúrgico del rectocele anterior mediante abordaje transperineal o transvaginal.Mejora en el estreñimiento, tiempo de operación, estancia hospitalaria, complicaciones, cambios en la presión anal, mejoría en la calidad de vida relacionada con el sexo evaluada por el cuestionario PISQ-12 e incidencia de dispareunia postoperatoria.Sesenta y cuatro pacientes de sexo femenino de una edad media de 43.5 años ingresaron al ensayo. No hubo diferencias significativas entre los dos grupos con respecto al tiempo de operación. La reparación transperineal tuvo una estancia hospitalaria significativamente más prolongada que la reparación transvaginal (2.4 Vs 2.1 días, p = 0.03). No hubo diferencias significativas entre ambos grupos con respecto a las complicaciones postoperatorias y la recurrencia del rectocele. Se registró una disminución significativa en las puntuaciones de estreñimiento en ambos grupos a los 6 y 12 meses después de la cirugía. La disminución en las puntuaciones de estreñimiento después de la reparación transvaginal fue significativamente mayor que después de la reparación transperineal a los 6 y 12 meses después de la operación. Aunque las presiones anales de reposo y compresión aumentaron significativamente a los 12 meses después de la reparación transperineal, no mostraron cambios significativos después de la reparación transvaginal. La mejora en la calidad de vida relacionada con el sexo fue significativamente mayor en la reparación transvaginal que en el grupo de reparación transperineal a los 6 y 12 meses después de la cirugía. La dispareunia mejoró después de la reparación transvaginal y empeoró después de la reparación transperineal, sin embargo, este cambio fue insignificante.Estudio de un solo centro que comprende un número relativamente pequeño de pacientes.La reparación transvaginal del rectocele logró una mejoría en el estreñimiento y la calidad de vida relacionada con el sexo que la reparación transperineal. Los cambios en la dispareunia después de ambas técnicas no fueron significativos. Consulte Video Resumen en http://links.lww.com/DCR/B148.Ensayos clínicos. Identificador del gobierno: NCT03801291.