Abstract:

BACKGROUND:Methods of treatment of rectocele include transperineal, transvaginal, and transanal approaches, and ventral rectopexy. OBJECTIVE:The present randomized study aimed to compare the outcome of transperineal repair and transvaginal repair of anterior rectocele. DESIGN:Randomized, single-blinded clinical trial. SETTING:Colorectal Surgery Unit, Mansoura University Hospitals. PATIENTS:Adult female patients with anterior rectocele complaining of obstructed defecation syndrome. INTERVENTIONS:Surgical treatment of anterior rectocele via transperineal or transvaginal approach. MAIN OUTCOME MEASURES:Improvement in constipation, operation time, hospital stay, complications, changes in anal pressures, improvement in sexual-related quality of life assessed by the PISQ-12 questionnaire, and incidence of dyspareunia postoperatively. RESULTS:Sixty-four female patients of a mean age of 43.5 years were entered into the trial. There was no significant difference between the two groups regarding the operation time. Transperineal repair had significantly longer hospital stay than transvaginal repair (2.4 Vs 2.1 days, p=0.03). There was no significant difference between both groups regarding postoperative complications and recurrence of rectocele. Significant decrease in the constipation scores was recorded in both groups at 6 and 12 months after surgery. The decrease in the constipation scores after transvaginal repair was significantly higher than after transperineal repair at 6 and 12 months postoperatively. While resting and squeeze anal pressures were significantly increased at 12 months after transperineal repair, they did not show significant change after transvaginal repair. Improvement in sexual-related quality of life was significantly higher in the transvaginal repair than the transperineal repair group at 6 and 12 months after surgery. Dyspareunia improved after transvaginal repair and worsened after transperineal repair, yet this change was insignificant. LIMITATIONS:Single center study comprising relatively small number of patients. CONCLUSION:Transvaginal repair of rectocele achieved better improvement in constipation and sexual-related quality of life than transperineal repair. Changes in dyspareunia after both techniques were not significant. See Video Abstract at http://links.lww.com/DCR/B148 TRIAL REGISTRATION:: Clinicaltrials. gov identifier: NCT03801291.