Transperineal with or without levatorplasty vs transanal repair for rectocele in obstructed defecation

Purpose: this study was undertaken to evaluate the results of transperineal repair with or without levator ani repair and transrectal repair of rectocele as regards both anatomic and symptomatic concerns.
Methods: between December 1998 and December 2000, we performed a prospective study of 48 female patients with obstructed defecation due to rectocele. All patients were studied prospectively according' to a fixed protocol that included clinical evaluation, defecography, and manometric studies, which were performed preoperatively, and 6 months postoperatively. Transperineal repair was done in 31 patient (15 with levator ani repair) and transrectal repair in 17 patients.
Results: six months postoperatively there was a significant clinical improvement in all patients except those who underwent transrectal repair. Postoperative defecography showed decrease of rectocele size in all patients but significant improvement in rectal - rectocele evacuation occurred only in patients with transperineal repair. Postoperative manometric studies showed a significant decrease in the Urge To Defecate Volume (UTDV) and Maximum Reflex Volume (MRV) in transperineal approaches. There was a significant difference between patients who did or did not feel improved by surgery in the percentage reduction in the volume at which an urge to defecate was elicited (UTDV) and the Maximal inhibitory anal Reflex Volume (MRV) in all surgical approaches.
Conclusion: Rectocele repair improves anorectal function by improving the rectal urge sensitivity. This study displays the efficacy of transperineal approach with levator ani repair. Decrease of UTDV, MRV, reduction of rectocele size and complete evacuation were considered the convenient parameters for the success of surgery.