Transanal repair of rectocele: prospective assessment of functional outcome and quality of life.

Abstract

This study aimed to assess the functional outcome of transanal repair of rectocele using patient symptom scores and quality of life (QOL) instruments. Patients who underwent transanal repair for symptomatic rectocele between February 2012 and August 2017 were included. This study was a retrospective analysis of prospectively collected data. A standard questionnaire including the Constipation Scoring System (CSS), the Fecal Incontinence Severity Index (FISI) and QOL instruments [Patient Assessment of Constipation (PAC)-QOL, Fecal Incontinence QOL Scale, Short-Form 36 Health Survey (SF-36)] was administered before and after the operation. Physiological assessment and proctography were performed before and after the operation. Thirty patients were included. The median follow-up was 36 (6-72) months. Postoperative proctography showed a reduction in rectocele size [34 mm (14-52 mm) vs 10 mm (0-28 mm), P<0.0001]. Physiological assessment showed no significant postoperative changes. Constipation was improved in 15/21 patients (71%) at 1year and 14/20 patients (70%) at the mid-term follow-up. The CSS score reduced at 3months [12 (8-12) vs 6 (1-12), P<0.0001] and remained significantly reduced over time until the mid-term follow-up. Faecal incontinence was improved in two-thirds patients at 1year. Four patients developed new-onset faecal incontinence. All the PAC-QOL scale scores significantly improved over time until 1year, while two of the eight SF-36 scale scores showed significant postoperative improvement. Transanal repair for rectocele improves constipation and constipation-specific QOL.