Transanal repair for treatment of rectocele in obstructed defaecation: manual or stapled

Abstract

Our aim is to evaluate the results of transanal repair of rectocele, either manual or stapled, considering the anatomic, manometric and symptomatic improvement. Forty-five female patients with obstructed defaecation due to anterior rectocele were operated on in the Colorectal Surgery Unit, Mansoura University Hospital, after history taking, detailed questionnaire analysis, barium enema, anorectal manometric studies, EMG studies, anal endosonography, balloon expulsion test, colonic transit time and defaecographic studies. Transanal manual repair was performed for 23 patients (group 1), and transanal stapled repair (group 2) was performed for 22 patients. Postoperative complications were recorded, and the patients were followed up for 1 year. Functional results were evaluated at 3, 6 and 12 months after surgery by questionnaire, anorectal manometry and evacuation proctography. Time of operation and hospital stay were significantly shorter in group 2. Postoperatively, there was no mortality or major morbidity. Two patients in group 1 experienced temporary anal incontinence (A3 and B1 stages). There were no reported adverse effects on sexual life, but significant clinical improvement was observed in both groups after surgery. Manometrically, there was a significant improvement in MARP, FLAC, RS, UTDV and MTV in both groups (significantly better in the early postoperative period in the stapled group). Also, follow-up defaecographic findings showed a significant decrease in the rectocele size in all the patients. Transanal repair of rectocele is a safe and effective technique in improving symptomatic rectocele. Stapled repair offers the advantage of short operative time, no comorbidity, and shorter hospital stay.