Anatomical and functional outcomes of surgical treatment of rectocele with internal rectal intussusception

Abstract

AIM: to estimate anatomical and functional outcomes of surgical treatment for rectocele combined with rectal intussusception.PATIENTS AND METHODS: the retrospective study included 96 patients with rectocele with internal rectal intussusception. The median age was 52 (21; 79) years. Laparoscopic rectocolposacropexy was performed in 59/96 (61%) patients with rectocele combined with high internal rectal intussusception, and Longo’s procedure was performed in 37/96 (39%) women with rectocele and low internal rectal intussusception.RESULTS: late outcomes were estimated in 71/96 (74%) patients. The median follow up was 16 (6; 72) months. No complications occurred after laparoscopic rectocolposacropexy. Two (5%) patients had bowel movements up to 8–10 times a day after Longo procedure right after the surgery. After 2 months, bowel movements decreased to 2–3 times a day. Normal residual volume of the rectum after the Longo procedure was detected in 16/37 patients, while laparoscopic rectocolposacropexy did not affect it (p = 0.01). The median rectocele size after surgery in both groups decreased from 5.0 cm to 2.7 cm (p < 0.0001). High rectal intussusception persisted in 20/59 (34%) patients after rectocolposacropexy, low intussusception — in 15/37 (40%) after Longo procedure. According to the original scale-questionnaire, a decrease in the manifestations of SOD was noted in 20/31 (65%) patients after Longo procedure and in 14/40 (35%) patients after rectocolposacropexy (p = 0.018). Improvement in the quality of life (PFDI questionnaire) after the surgery was registered in both groups without significant differences (p = 0.2). The severity of the effect was 22 (6-48) points (p < 0.0001).CONCLUSION: surgery for complex rectocele, regardless of the operation, does not always provide complete anatomical correction of the defects of the rectum. Laparoscopic rectocolposacropexy is inferior to the Longo procedure in functional outcomes.