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World Journal of Gastrointestinal... Sep 2021Rectocele is commonly seen in parous women and sometimes associated with symptoms of obstructed defecation syndrome (ODS).
BACKGROUND
Rectocele is commonly seen in parous women and sometimes associated with symptoms of obstructed defecation syndrome (ODS).
AIM
To assess the current literature in regard to the outcome of the classical transperineal repair (TPR) of rectocele and its technical modifications.
METHODS
An organized literature search for studies that assessed the outcome of TPR of rectocele was performed. PubMed/Medline and Google Scholar were queried in the period of January 1991 through December 2020. The main outcome measures were improvement in ODS symptoms, improvement in sexual functions and continence, changes in manometric parameters, and quality of life.
RESULTS
After screening of 306 studies, 24 articles were found eligible for inclusion to the review. Nine studies (301 patients) assessed the classical TPR of rectocele. The median rate of postoperative improvement in ODS symptoms was 72.7% (range, 45.8%-83.3%) and reduction in rectocele size ranged from 41.4%-95.0%. Modifications of the classical repair entailed omission of levatorplasty, addition of implant, concomitant lateral internal sphincterotomy, changing the direction of plication of rectovaginal septum, and site-specific repair.
CONCLUSION
The transperineal repair of rectocele is associated with satisfactory, yet variable, improvement in ODS symptoms with parallel increase in quality-of-life score. Several modifications of the classical TPR were described. These modifications include omission of levatorplasty, insertion of implants, performing lateral sphincterotomy, changing the direction of classical plication, and site-specific repair. The indications for these modifications are not yet fully clear and need further prospective studies to help tailor the technique to rectocele patients.
PubMed: 34621481
DOI: 10.4240/wjgs.v13.i9.1063 -
Journal of Clinical Medicine Jan 2023Background: Rectocele is defined as a defect in the rectovaginal septum, causing symptoms like obstructed defecation syndrome (ODS), vaginal bulging, etc. Once the...
Background: Rectocele is defined as a defect in the rectovaginal septum, causing symptoms like obstructed defecation syndrome (ODS), vaginal bulging, etc. Once the rectocele is larger than 3 cm and/or symptomatic, surgery should be considered. The surgical approach can be either transvaginal, transanal or transperineal. Two of the most common procedures in treating rectocele are posterior colporrhaphy (PC) and stapled trans anal rectal resection (STARR). The purpose of this study was to compare surgical outcomes of both procedures. Methods: This is a retrospective cohort study. Included were patients of the age of 18−85 years that underwent either STARR (n = 49 patients) or PC (n = 24 patients) procedures after a full clinical (defecography and physical exam before and after the surgery) and physiologic (a detailed questionnaire before and after the surgery) surveys. Symptoms of ODS before and after surgery were evaluated by questioners. Results: Preoperatively, the patients in the STARR group had significantly higher rates of ODS: straining (90.9% vs. 65.2%), incomplete evacuation (100% vs. 69.6%), hard stool (57.8% vs. 43.5%), sense of obstruction (76.1% vs. 56.5%), and use of digitation (64.4% vs. 47.8%), or laxatives (70% vs. 47.8%), p < 0.001. Anatomically, the mean rectocele size was smaller for the STARR group, compared to the PC group (3.8 ± 1.4 vs. 5.3 ± 2.2 cm, respectively, p < 0.001). Postoperatively, in the STARR group, higher rates of patients complained about straining (36.4% vs. 21.7%, p < 0.001) and use of digitation (64.4% vs. 26.1%, p < 0.001), whereas lower rates of patients complained about incomplete evacuation (41.2% vs. 56.5%, p = 0.05) and sense of obstruction (17.6%, vs. 34.8%, p = 0.03), compared to the PC group. Among patients who underwent the STARR procedure, a decrease in rates of all symptoms was noted (straining 54.5%, incomplete evacuation 58.8%, hard stool 29.2%, sense of obstruction 58.5%, use of digitation 0.1%, and use of laxatives 31.5%). Both procedures are effective in reducing rectocele size (STARR- 1.9 ± 1 cm, PC- 3.1 ± 1). Conclusions: Both STARR and PC are effective in treating rectocele. It seems that the STARR procedure is superior to the PC procedure in treating symptoms of ODS.
PubMed: 36675607
DOI: 10.3390/jcm12020678 -
Biomedical Papers of the Medical... Dec 2023The aim of this retrospective study was to try to find correlations between different diagnoses established by clinical examination, anorectal manometry and...
AIMS
The aim of this retrospective study was to try to find correlations between different diagnoses established by clinical examination, anorectal manometry and MRI-defecography and, the association with psychiatric disorders.
METHODS
44 patients (median age 53.81 years) presenting with intestinal motility disorders and who underwent clinical, biological and psychiatric examination, dynamic defecographic-MRI (resting, squeezing, straining, defecation and evacuation phases), anorectal manometry, colonoscopy. MRI was performed using the 1,5 T.
RESULTS
MRI-defecography revealed the following changes: anismus (16), rectocele (12), pelvic floor dysfunction (6), peritoneocele (2), cervical-cystic-ptosis (1), rectal prolapse (6), and in 1 case the examination was normal. Hypertonic anal sphincter (16) and lack of defecation reflex (12) at anorectal manometry correlated with anismus in all patients at MRI-defecography. Lack of inhibitor anal reflex (6) was associated with rectocele (4), cervix-cysto-ptosis (1) and peritoneocele (2). Anxiety (11), depression (6) and anxiety-depressive disorders (10) were found in 27/44, somatization disorders in 9/44 and no psychiatric changes in 8/44 cases.
CONCLUSION
As multiparous women are at risk for outlet obstruction constipation, MRI-defecography is suggested in this category. There is good correlation between diagnosis using anorectal manometry and MRI-defecography in patients with terminal constipation and anismus. Lower defecation dysfunction is often associated with psychiatric disorders.
Topics: Humans; Female; Middle Aged; Defecation; Rectocele; Defecography; Retrospective Studies; Constipation; Magnetic Resonance Imaging
PubMed: 35582728
DOI: 10.5507/bp.2022.023 -
BMC Women's Health Apr 2021The aim of this study is to examine the relationship between rectal-vaginal pressure and symptomatic rectocele in patients with pelvic organ prolapse (POP).
OBJECTIVE
The aim of this study is to examine the relationship between rectal-vaginal pressure and symptomatic rectocele in patients with pelvic organ prolapse (POP).
METHOD
Patients with posterior vaginal prolapse staged III or IV in accordance with the POP Quantitation classification method who were scheduled for pelvic floor reconstructive surgery in the years 2016-2019 were included in the study. Rectocele was diagnosed using translabial ultrasound, and obstructed defecation (OD) was diagnosed in accordance with the Roma IV diagnostic criteria. Both rectal and vaginal pressure were measured using peritron manometers at maximum Vasalva. To ensure stability, the test was performed three times with each patient.
RESULTS
A total of 217 patients were enrolled in this study. True rectocele was diagnosed in 68 patients at a main rectal ampulla depth of 19 mm. Furthermore, 36 patients were diagnosed with OD. Symptomatic rectocele was significantly associated with older age (p < 0.01), a higher OD symptom score (p < 0.001), and a lower grade of apical prolapse (p < 0.001). The rectal-vaginal pressure gradient was higher in patients with symptomatic rectocele (37.4 ± 11.7 cm HO) compared with patients with asymptomatic rectocele (16.9 ± 8.4 cm HO, p < 0.001), and patients without rectocele (17.1 ± 9.2 cm HO, p < 0.001).
CONCLUSION
The rectal-vaginal pressure gradient was found to be a risk factor for symptomatic rectocele in patients with POP. A rectal-vaginal pressure gradient of > 27.5 cm HO was suggested as the cut-off point of the elevated pressure gradient.
Topics: Aged; Female; Humans; Pelvic Organ Prolapse; Rectocele; Rectum; Ultrasonography; Vagina
PubMed: 33879140
DOI: 10.1186/s12905-021-01304-6 -
Women's Health (London, England) Jul 2015Defecating disorders are a common and complex problem. There are a range of anatomical and functional bowel abnormalities that can lead to this condition. Treatment is... (Review)
Review
Defecating disorders are a common and complex problem. There are a range of anatomical and functional bowel abnormalities that can lead to this condition. Treatment is difficult and needs a multidisciplinary approach. First line treatment for defecating disorders is conservative. For those that fail conservative treatment, some may respond to surgical therapy but with variable results. The aim of this review is to offer an overview of defecating disorders as well as provide an algorithm on how to diagnose and treat them with the help of a multidisciplinary and multimodal approach.
Topics: Biofeedback, Psychology; Constipation; Diagnostic Imaging; Diet; Female; Gastrointestinal Agents; Gastrointestinal Transit; Humans; Intussusception; Manometry; Physical Examination; Rectocele; Therapeutic Irrigation; Women's Health
PubMed: 26238417
DOI: 10.2217/whe.15.25 -
The Yale Journal of Biology and Medicine Jul 2005Constipation is a relatively common problem affecting 15 percent of adults in the Western world, and over half of these cases are related to pelvic floor disorders. This... (Review)
Review
INTRODUCTION
Constipation is a relatively common problem affecting 15 percent of adults in the Western world, and over half of these cases are related to pelvic floor disorders. This article reviews the clinical presentation and diagnostic approach to posterior pelvic floor disorders, including how to image and treat them.
METHODS
A Pubmed search using keywords "rectal prolapse," "rectocele," "perineal hernia," and "anismus" was performed, and bibliographies of the revealed articles were cross-referenced to obtain a representative cross-section of the literature, both investigational studies and reviews, that are currently available on posterior pelvic floor disorders.
DISCUSSION
Pelvic floor disorders can occur with or without concomitant physical anatomical defects, and there are a number of imaging modalities available to detect such abnormalities in order to decide on the appropriate course of treatment. Depending on the nature of the disorder, operative or non-operative therapy may be indicated.
CONCLUSION
Correctly diagnosing pelvic floor disorders can be complex and challenging, and the various imaging modalities as well as clinical history and exam must be considered together in order to arrive at a diagnosis.
Topics: Aged; Constipation; Female; Hernia; Humans; Male; Pelvic Floor; Rectal Diseases; Rectal Prolapse; Rectocele
PubMed: 16720016
DOI: No ID Found -
Gastroenterology Report Oct 2021Transperineal ultrasonography has been used as a diagnostic imaging modality for rectocele for many years. However, the consistency of ultrasonography and defecography...
BACKGROUND
Transperineal ultrasonography has been used as a diagnostic imaging modality for rectocele for many years. However, the consistency of ultrasonography and defecography in evaluating the severity of rectocele was not satisfactory. This study aimed to evaluate the agreement in the measurement of rectocele parameters between the two methods in different positions and provide clinical implications for the diagnosis of rectocele.
METHODS
In this pilot study, participants were recruited in an outpatient clinic of a tertiary hospital between December 2017 and December 2019. All participants separately underwent defecation proctography at sitting and squatting positions, and undertook transperineal ultrasonography at left lateral, sitting, and squatting positions. The consistency of ultrasonography and defecography was evaluated.
RESULTS
Thirty female volunteers with rectocele were included in this study. The degree of anorectal angle was significantly larger at rest and during contraction, maximal Valsalva, and evacuation; the depth of the rectocele was significantly deeper during maximal Valsalva and evacuation; and the length of the perineum descending was significantly longer during contraction and maximal Valsalva in using squatting position compared to the sitting position when performing the defecation proctography. The degree of anorectal angle, the depth of rectocele, the area of levator hiatus, and the volume of the rectocele were significantly different in using squatting, sitting, and left lateral positions when performing the transperineal ultrasonography. Bland-Altman semi-quantitative plots showed good consistency in the measurement of the anorectal angle and the depth of the rectocele between proctography and ultrasonography in both sitting and squatting positions.
CONCLUSIONS
The findings of our study may be considered as the preliminary evidence to support the use of transperineal ultrasonography with sitting and squatting positions as the imaging test of choice for evaluating patients with rectocele.
PubMed: 34733532
DOI: 10.1093/gastro/goab019 -
World Journal of Gastroenterology Sep 2016Obstructed defecation syndrome (ODS) is a functional disorder commonly encountered by colorectal surgeons and gastroenterologists, and greatly affects the quality of... (Review)
Review
Obstructed defecation syndrome (ODS) is a functional disorder commonly encountered by colorectal surgeons and gastroenterologists, and greatly affects the quality of life of patients from both societal and psychological aspects. The underlying anatomical and pathophysiological changes of ODS are complex. However, intra-rectal intussusception and rectocele are frequently found in patients with ODS and both are thought to play an important role in the pathogenesis of ODS. With the development of evaluation methods in anorectal physiology laboratories and radiology studies, a great variety of new operative procedures, especially transanal procedures, have been invented to treat ODS. However, no procedure has been proved to be superior to others at present. Each operation has its own merits and defects. Thus, choosing appropriate transanal surgical procedures for the treatment of ODS remains a challenge for all surgeons. This review provides an introduction of the current problems and options for treatment of ODS and a detailed summary of the essential assessments needed for patient evaluation before carrying out transanal surgery. Besides, an overview of the benefits and problems of current transanal surgical procedures for treatment of ODS is summarized in this review. A report of clinical experience of some transanal surgical techniques used in the authors' center is also presented.
Topics: Anal Canal; Constipation; Defecation; Defecography; Digestive System Surgical Procedures; Female; Humans; Male; Postoperative Complications; Quality of Life; Rectal Diseases; Rectocele; Rectum; Surgical Stapling; Surveys and Questionnaires; Treatment Outcome
PubMed: 27672293
DOI: 10.3748/wjg.v22.i35.7983 -
Neurourology and Urodynamics Jan 2020Oxygen plays a crucial role in wound healing after prolapse surgery. Trauma to the vaginal vasculature might limit the delivery of oxygen to the surgical wound, which...
AIMS
Oxygen plays a crucial role in wound healing after prolapse surgery. Trauma to the vaginal vasculature might limit the delivery of oxygen to the surgical wound, which may negatively affect wound healing and regeneration of connective tissue. This possibly increases the future risk of recurrence. We aimed to determine the effects of vaginal prolapse surgery on the microcirculation of the vaginal wall.
METHODS
We evaluated the vaginal microcirculation in healthy participants without known vascular disease undergoing anterior and/or posterior colporrhaphy. We used incident dark-field imaging for in vivo assessment before and after (1 day, 2 weeks, and 6 weeks) surgery. We studied perfusion (microvascular flow index [MFI]), angioarchitecture (morphology/layout of microvessels) and capillary density.
RESULTS
Ten women were included. Interindividual differences were observed 1 day postoperatively with regard to perfusion and angioarchitecture. Microvascular flow at the surgical site was absent or significantly reduced in some participants, whereas normal microvascular flow was observed in others (MFI range 0-3). Perfusion and angioarchitecture had been restored in all participants after 6 weeks (MFI range 2-3), regardless of the extent of vascular trauma 1 day postoperatively.
CONCLUSIONS
The difference in the extent of vascular trauma between women undergoing seemingly identical surgical procedures suggests that some individuals are more susceptible to vascular trauma than others. Delivery of oxygen to the wound and subsequent wound healing may be compromised in these cases, which could be related to the development of anatomical recurrence. Future studies should investigate whether there is a relationship between the vaginal microvasculature and the recurrence of prolapse.
Topics: Aged; Female; Gynecologic Surgical Procedures; Humans; Microcirculation; Microvessels; Middle Aged; Pelvic Organ Prolapse; Recurrence; Surgical Mesh; Vagina
PubMed: 31691336
DOI: 10.1002/nau.24203 -
Annals of Coloproctology Nov 2022This study was performed to assess the long-term annual functional outcomes and quality of life (QOL) after transanal rectocele repair.
PURPOSE
This study was performed to assess the long-term annual functional outcomes and quality of life (QOL) after transanal rectocele repair.
METHODS
We evaluated retrospectively collected data from patients who underwent transanal repair for symptomatic rectocele between February 2012 and December 2018. The Constipation Scoring System (CSS), the Fecal Incontinence Severity Index (FISI), and several QOL questionnaires (e.g., the Patient Assessment of Constipation-QOL [PAC-QOL], Fecal Incontinence QOL, and the 36-Item Short Form Survey [SF-36]) were administered before surgery and annually after surgery. Additionally, physiological assessments and defecography were performed before and after surgery. Substantial symptom improvement, indicated by at least a 50% reduction in the CSS or FISI score, was evaluated postoperatively. All postoperative follow-up results were compared with the preoperative data.
RESULTS
Thirty-two patients were included in the study. The median follow-up period was 5 years (range, 0.5-7 years). Postoperative defecography showed that the rectocele size significantly decreased (P<0.0001). However, the physiological assessment did not reveal postoperative changes. The CSS score 1 year after surgery was significantly lower than the preoperative score (P<0.0001) and remained significantly low until the long-term follow-up. Constipation improved by more than 80% 2 to 5 years postoperatively, and fecal incontinence improved in 2/3 of the patients after 5 years. The PAC-QOL scores significantly improved (all P<0.05) over time until the 3-year and long-term follow-ups, and 6 of the 8 SF-36 scores significantly improved at specific points postoperatively.
CONCLUSION
Transanal rectocele repair provides long-term improvement for constipation and constipation-specific QOL.
PubMed: 36377333
DOI: 10.3393/ac.2022.00283.0040