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Techniques of rectocele repair and their effects on bowel function

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Abstract

Gynecologists have traditionally evaluated rectocele repair by its effect on vaginal function; coloproctologists have traditionally evaluated its effect on bowel function. Hence different operative criteria and surgical techniques have arisen, but with very little prospective, objective evaluation. The purpose of this review is to describe the surgical techniques used to repair the rectocele and the most common investigations used during its evaluation. Anorectal investigations identify concomitant pathology, may explain pathophysiology, provide objective outcome criteria and attempt to predict the patients that will most benefit from surgery. However, because of the complex neuromuscular, physiological and mechanical interactions that contribute to impaired rectal emptying, their usefulness in improving functional outcome has been limited. Many patients experience improvement, but still are left with some symptoms of impaired defecation despite anatomic correction.

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References

  1. Cavallo G, Salzano A, Grassi R, De Lillo ML. Functional intraperitoneneal pouch of rectal wall (posterior rectocele).Dis Colon Rectum 1993;36:179–181

    PubMed  Google Scholar 

  2. Kiff ES, Barnes PRH, Swash M. Evidence of pudendal neuropathy in patients with perineal descent and chronic straining at stool.Gut 1983;25:1279–1282

    Google Scholar 

  3. Siproudhis L, Dautreme S, Ropert A et al. Dyschezia and rectocele — a marriage of convenience? Physiologic evaluation of the rectocele in a group of 52 women complaining of difficulty in evacuation.Dis Colon Rectum 1993;36:1030–1036

    PubMed  Google Scholar 

  4. Wiskind AK, Creighton SM, Stanton SL. The incidence of genital prolapse after the Burch colposuspension.Am J Obstet Gynecol 1992;167:399–405

    PubMed  Google Scholar 

  5. Virtanen HS, Mäkinen JI. Retrospective analysis of 711 patients operated on for pelvic relaxation in 1983–1989.J Gynecol Obstet 1993:41109–42115

  6. Gilpin SA, Gosling JA, Smith JA. The pathogenesis of genitourinary prolapse and stress incontinence of urine. A histological and histochemical study.Br J Obstet Gynaecol 1989;96:15–23

    PubMed  Google Scholar 

  7. Allen RE, Hosker GL, Smith ARB, Warrell DW. Pelvic floor damage and childbirth: a neurophysiological study.Br J Obstet Gynaecol 1990;97:770–779

    PubMed  Google Scholar 

  8. Goff BH. Histological study of the perivaginal fascia in a nullipara.Surg Gynecol Obstet 1931;52:32–42

    Google Scholar 

  9. Uhlenhuth E, Nolley GW. Vaginal fascia, a myth?Obstet Gynecol 1957;10:349–358

    PubMed  Google Scholar 

  10. Ricci JV, Thom CH, Kron WL. Cleavage planes in reconstructive vaginal plastic surgery.Am J Surg 1948;76:354–363

    Google Scholar 

  11. Ricci JV, Lisa JR, Thom CH, Kron WL. The relationship of the vagina to adjacent organs in recnstructive surgery: a histologic study.Am J Surg 1947;74:387–410

    Google Scholar 

  12. Milley PS, Nichols Ch. A correlative investigation of the human rectovaginal septum.Anat Rec 1968;163:443–444

    Google Scholar 

  13. Weber AM, Walters MD. What is vaginal fascia?AUGS Quarterly Report 1995;13(3)

  14. Watson SJ, Loder PB, Halligan S, Bartram CI, Kamm, Phillips RKS. Transperineal repair of symptomatic rectocele with Marlex mesh: a clinical, physiological and radiologic assessment of treatment.J Am Coll Surg 1996;183:257–261

    PubMed  Google Scholar 

  15. Øster S, Astrup A. A new vaginal operation for recurrent and large rectocele using dermis transplant.Acta Obstet Gynecol Scand 1981;60:493–495

    PubMed  Google Scholar 

  16. Berglas B, Rubin IC. Study of the supportive structures of the uterus by levator myography.Surg Gynecol Obstet 1953;97:677–692

    PubMed  Google Scholar 

  17. Nichols DH. Posterior colporrhaphy and perineorrhaphy: Separate and distinct operations.Am J Obstet Gynecol 1991;164:714–721

    PubMed  Google Scholar 

  18. Marks MM. The rectal side of the rectocele.Dis Colon Rectum 1967;10:387–388

    PubMed  Google Scholar 

  19. Sarles JC, Arnoud A, Selezneff I, Olivier S. Endo-rectal repair of rectocele.Int J Colorect Dis 1989;4:167–171

    Google Scholar 

  20. Nicholls DH, Randall CL. Posterior colporrhaphy and perineorrhaphy. In: Vaginal surgery, 3rd edn. Baltimore: Williams & Wilkins, 1989:269–293

    Google Scholar 

  21. Holley RL. Enterocele: a review.Obstet Gynecol Surv 1994;49:284–293

    PubMed  Google Scholar 

  22. Altringer WE, Saclarides TJ, Dominguez JM, Brubaker LT, Smith CS. Four-contrast defecography: pelvic ‘floor-oscopy’.Dis Colon Rectum 1995;38:695–699

    PubMed  Google Scholar 

  23. Bump RC, Mattiasson A, Bø K et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction.Am J Obstet Gynecol 1996;175:10–17

    PubMed  Google Scholar 

  24. Baden W, Walker T. Surgical repair of vaginal defects. Philadelphia: JB Lippincott, 1992

    Google Scholar 

  25. Halligan S, Bartram CI. Evacuation proctography combined with positive contrast peritoneography to demonstrate pelvic floor hernias.Abdom Imag 1995;20:442–445

    Google Scholar 

  26. Bremmer S, Ahlbäck S-O, Udèn R, Mellgren A. Simultaneous defecography and peritoneography in defecation disorders.Dis Colon Rectum 1995;38:969–973

    PubMed  Google Scholar 

  27. Sentovich SM, Rivela LJ, Thorson AG, Dhristensen MA, Blatchford GJ. Simultaneous dynamic proctography and peritoneography for pelvic floor disorders.Dis Colon Rectum 1995;38:912–915

    PubMed  Google Scholar 

  28. Shorvon PJ, McHugh S, Diamant NE, Somers S, Stevenson GW. Defecography in normal volunteers: results and implications.Gut 1989;30:1737–1749

    PubMed  Google Scholar 

  29. Bartram CI, Turnbull GK, Lennard-Jones JE. Evacuation proctography: an investigation of rectal expulsion in 20 subjects without defecatory disturbance.Gastroint Radiol 1988;13:72–80

    Google Scholar 

  30. Capps WR. Rectoplasty and perineoplasty for the symptomatic rectocele: a report of fifty cases.Dis Colon Rectum 1975;18:237–244

    PubMed  Google Scholar 

  31. Halligan S, Bartram CI. Is barium trapping in rectoceles significant?Dis Colon Rectum 1995;38:764–768

    PubMed  Google Scholar 

  32. Kelvin FM, Maglinte DDT, Benson JT. Evacuation proctography (defecography); an aid to the investigation of pelvic floor disorders.Obstet Gynecol 1994;83:307–314

    PubMed  Google Scholar 

  33. Halligan S, McGee S, Bartram CI. Quantification of evacuation proctography.Dis Colon Rectum 1994;37:1151–1154

    PubMed  Google Scholar 

  34. Mellgren A, Anzen BV, Nilsson BY et al. Results of rectocele repair. A prospective study.Dis Colon Rectum 1995;38:7–13

    PubMed  Google Scholar 

  35. Murthy VK, Orkin BA, Smith LE, Glassman LM. Excellent outcome using selective criteria for rectocele repair.Dis Colon Rectum 1996;39:374–378

    PubMed  Google Scholar 

  36. Yoshioka K, Matsui Y, Yamada O et al. Physiologic and anatomic assessment of patients with rectocele.Dis Colon Rectum 1995;38:1991;34:704–708

    Google Scholar 

  37. Van Dam JH, Ginai AZ, Gosselink MJ, Huisman WM, Bonjer HJ, Hop WCJ, Schouten WR. Role of defecography in predicting clinical outcome of rectocele repair.Dis Colon Rectum 1997;40:201–207

    PubMed  Google Scholar 

  38. Johansson C, Nilsson BY, Homström B, Dolk A, Mellgren A. Association between rectocele and paradoxical sphincter response.Dis Colon Rectum 1992;35:503–509

    PubMed  Google Scholar 

  39. Bleijenberg G, Kuijpers HC. Treatment of the spastic pelvic floor syndrome with biofeedback.Dis Colon Rectum 1987;30:108–111

    PubMed  Google Scholar 

  40. Dolk A, Johansson C, Holmström B, Nilsson BY, Frostell C. The effect of yoga on puborectalis paradox.Int J Colorect Dis 1991;6:139–142

    Google Scholar 

  41. Agosta AM. Clinical evaluation. In: Benson JT, ed. Female pelvic floor disorders: investigation and management. New York: WW Norton and Company, 1992:59–69

    Google Scholar 

  42. Bartram CI, Mahieu PHG. Evacuation proctography and anal endosonography. In: Henry MM, Swash M, eds. Coloproctology and the pelvic floor, 2nd edn. Oxford: Butterworth-Heinemann 1992:146–171

    Google Scholar 

  43. Oettle GJ, Roe AM, Bartolo DC, Mortensen NJ. What is the best way of measuring perineal descent? A comparison of radiographic and clinical methods.Br J Surg 1985;72:999–1001

    PubMed  Google Scholar 

  44. Goei R. Anorectal function in patients with defecation disorders and asymptomatic subjects: evaluation with defecography.Radiology 1990;174:121–123

    PubMed  Google Scholar 

  45. Jorge JMN, Yang Y-K, Wexner SD. Incidence and clinical significance of sigmoidoceles as determined by a new classification system.Dis Colon Rectum 1994;37:1112–1117

    PubMed  Google Scholar 

  46. Fenner DE. Diagnosis and assessment of sigmoidoceles.Am J Obstet Gynecol 1996;175:1438–1442

    PubMed  Google Scholar 

  47. Hutchinson R, Mostafa AB, Grant EA, Smith NB, Deen KI, Harding LK, Kumar D. Scintigraphic defecography: quantitative and dynamic assessment of anorectal function.Dis Colon Rectum 1993;36:1132–1138

    PubMed  Google Scholar 

  48. Papachrysostomou M, Griffin TMJ, Ferrington C, Merrick MV, Smith AN. A method of computerised isotope dynamic proctography.Eur J Nucl Med 19;431–435

  49. Papachrysostomou M, Stevenson AJM, Ferrington C, Merrick MV, Smith AN. Evaluation of isotope of isotope proctography in constipated patients.Int J Colorect Dis 1993;8:18–22

    Google Scholar 

  50. Hutchinson R, Mostafa AB, Kumar D. Rectoceles: are they important?Int J Colorect Dis 1993;8:232–233

    Google Scholar 

  51. Kahn MA, Stanton SL, Kumar D. Anorectal physiological effects of rectocele correction by posterior colporrhaphy or the transanal approach.Int Urogynecol J 1997;8:249,020b

    Google Scholar 

  52. Sultan AH, Kamm MA, Hudson CN, Thomas JM, Bartram CI. Anal-sphincter disruption during vaginal delivery.N Engl J Med 1993;329:1905–1911

    PubMed  Google Scholar 

  53. Cherry DA, Rothenberger DA. Pelvic floor physiology.Surg Clin North Am 1988;68:1217–1248

    PubMed  Google Scholar 

  54. Fowler CJ. Clinical neurophysiology. In: Stanton SLR, Monga A, eds. Clinical urogynaecology, 2nd edn. London: Churchill Livingstone, (in press)

  55. Beevors MA, Lubowski DZ, King DW, Carlton MA. Pudendal nerve function in women with symptomatic utero-vaginal prolapse.Int J Colorect Dis 1991;6:24–28

    Google Scholar 

  56. Benson T, McClellan E. The effect of vaginal dissection on the pudendal nerve.Obstet Gynecol 1993;82:387–389

    PubMed  Google Scholar 

  57. Spence-Jones C, Kamm MA, Henry MM, Hudson CN. Bowel dysfunction: a pathogenic factor in uterovaginal and urinary stress incontinence.Br J Obstet Gynaecol 1994;101:147–152

    PubMed  Google Scholar 

  58. Phillips S. Measurement of colonic transit. In: Kamm MA, Lennard-Jones, eds. Gastrointestinal transit: pathophysiology and pharmacology. Wrighton Biomedical Publishing, 1991:109–118

  59. Karlbom U, Graf WG, Hilsson S, Påhlman L. Does surgical repair of a rectocele improve rectal emptying?Dis Colon Rectum 1996;39:1296–1302

    PubMed  Google Scholar 

  60. Sandler RS, Drossman DA. Bowel habits in young adults not seeking health care.Dig Dis Sci 32:841–845

  61. Janssen LWM, van Dijke CF. Selection criteria for anterior rectal wall prolapse.Dis Colon Rectum 1994;37:1100–1107

    PubMed  Google Scholar 

  62. Halligan S, Bartram CI, Hall C, Wingate J. Enterocele revealed by simultaneous evacuation proctography and peritoneography: does defecation block exist?Am J Roentngenol 1996;167:461–466

    Google Scholar 

  63. Halligan S, Thomas J, Bartram C. Intrarectal pressures and balloon expulsion related to evacuation proctography.Gut 1995;37:100–104

    PubMed  Google Scholar 

  64. Block IR. Transrectal repair of rectocele using obliterative suture.Dis Colon Rectum 1986;29:707–711

    PubMed  Google Scholar 

  65. Kahn MA, Stanton SL. Letter to the editor 1997.Br J Obstet Gynecol 1997;104:972–973

    Google Scholar 

  66. Jeffcoate TNA. Posterior colpoperineorrhaphy.Am J Obstet Gynecol 1959;77:490–502

    PubMed  Google Scholar 

  67. Heslop JH. Piles and rectoceles.Aust NZ J Surg 1987;57:935–938

    Google Scholar 

  68. Arnold MW, Stewart WR, Aguilar PS. Rectocele repair. Four years' experience.Dis Colon Rectum 1990;33:684–687

    PubMed  Google Scholar 

  69. Kahn MA, Stanton SL. Posterior colporrhaphy: its effects on bowel and sexual function.Br J Obstet Gynaecol 1997;104:82–86

    PubMed  Google Scholar 

  70. Redding MD. The relaxed perineum and anorectal disease.Dis Colon Rectum 1965;8:279–282

    Google Scholar 

  71. Pitchford CA. Rectocoele: a cause of anorectal pathologic changes in women.Dis Colon Rectum 1967;10:464–466

    PubMed  Google Scholar 

  72. Sullivan ES, Leaverton GH, Hardwick CE. Transrectal perineal repair: an adjunct to improved function after anorectal surgery.Dis Colon Rectum 1968;11:106–114

    PubMed  Google Scholar 

  73. Delorme M. Sur le traitement des prolapsus du rectum totaux, par l'excision de la muqueuse rectale ou recto-colique.Cull Mem Soc Chir Paris 1900;24:499–518

    Google Scholar 

  74. Sehapayak S. Transrectal repair of rectocele: an extended armamentarium of colorectal surgeons. A report of 355 cases.Dis Colon Rectum 1985;28:422–433

    PubMed  Google Scholar 

  75. Infantino A, Masin A, Melega E, Dodi G, Lise M. Does surgery resolve outlet obstruction from rectocele?Int J Colorect Dis 1995;10:97–100

    Google Scholar 

  76. Khubchandani IT, Sheets JA, Stasik JJ, Hakki AR. Endorectal repair of rectocele.Dis Colon Rectum 1983;26:792–796

    PubMed  Google Scholar 

  77. Khubchandani IT, Clancy JP, Rosen L, Riether RD, Stasik JJ. Endorectal repair of rectocele revisited.Br J Surg 1997;84:89–91

    PubMed  Google Scholar 

  78. Richardson CA. The rectovaginal septum revisited. Its relationship to rectocele and its importance in rectocele repair.Clin Obstet Gynecol 1993;36:76–983

    Google Scholar 

  79. Pillai-Allen AV, Benson JT. Rectocele repair. Defect approach, an early review [abstract].AUGS 15th Annual Meeting, 1994

  80. Marek CB. Transverse repair for rectocele.South Med J 1965;62:749–752

    Google Scholar 

  81. Lyons TL, Winer WK. Laparoscopic rectocele repair using polyglactin mesh.J Am Gynecol Laparosc 1997;4:381–381

    Google Scholar 

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Authors and Affiliations

  1. St George's Hospital, London, UK

    S. L. Stanton

  2. Department of Obstetrics and Gynecology, University of Texas Medical Branch, 301 University Boulevard, 77555-0587, Galveston, TX, USA

    M. A. Kahn

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  1. M. A. Kahn
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  2. S. L. Stanton
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Kahn, M.A., Stanton, S.L. Techniques of rectocele repair and their effects on bowel function. Int Urogynecol J 9, 37–47 (1998). https://doi.org/10.1007/BF01900540

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