Functional and physiological outcome following transanal repair of rectocele

Background: Rectoceles are traditionally repaired transvaginally and sexual dysfunction can be a significant complication. The aim of this study was to evaluate the functional and physiological outcome following transanal repair of rectoceles. Methods: Forty-five patients of mean age 57.1 (range 34-78) years with a symptomatic anterior rectocele, selected by contrast retention greater than 15 per cent on isotope defaecography, underwent transanal repair of rectocele. Preoperative and postoperative symptoms were assessed by means of a questionnaire. A proportion of patients underwent anorectal physiology and isotope defaecography before and after surgery. Results: Median(range) follow-up was 24 (2-50) months. One patient developed a wound infection after surgery. Thirty-five patients reported an excellent, good or fair result, with seven reporting a moderate and three a poor result. There was a reduction in incomplete evacuation (P < 0.001) confirmed by isotope defaecography (mean(s.d.) rectal emptying before surgery 57(14) per cent versus 76(9) per cent after surgery; P = 0.020), and a reduction in vaginal (P < 0.001) and perineal (P = 0.004) digitation. Symptomatic feeling of prolapse (vaginal bulging) was significantly improved (P < 0.001). There was no increase in incontinence (P = 0.688). Resting and squeeze anal canal pressures were unchanged after operation. Surgery did not result in sexual dysfunction. Conclusion: Transanal repair of rectocele is a safe alternative to posterior colporrhaphy. It provides improvement in symptoms, reflected by anatomical improvement with minimal complications and no increase in dyspareunia.