Specific Changes in Manometric Parameters are Associated with Non-improvement in Symptoms after Rectocele Repair

Emile, Sameh Hany; Balata, Mohammed; Omar, Waleed; Khafagy, Wael; Elgendy, Hesham

doi:10.1007/s00192-020-04444-9

Cited by 7 publications

(7 citation statements)

References 18 publications

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“…Other investigators [5,17] reported a significant improvement in the rectal volumes after transanal rectocele repair with no changes in other manometric parameters. Similarly, Emile et al [22] observed a significant decrease in the thresholds of rectal sensations and MTV after transperineal repair of rectocele whereas the postoperative changes in the anal pressures were insignificant like the results of the present trial.…”

Section: Discussionsupporting

confidence: 86%

Horizontal versus vertical plication of the rectovaginal septum in transperineal repair of anterior rectocele: a pilot randomized clinical trial

et al. 2020

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Aim: Anterior rectocele is usually an asymptomatic condition in many women, yet it can be associated with obstructed defaecation syndrome (ODS). Transperineal repair of rectocele (TPR) has been followed by variable rates of improvement in ODS. The present pilot randomized clinical trial aimed to evaluate the outcome of TPR with vertical plication (VP) of the rectovaginal septum compared to horizontal plication (HP).Methods: Adult women with anterior rectocele were recruited to the study and were randomly allocated to one of two equal groups. The first group underwent TPR with VP of the rectovaginal septum and the second group underwent TPR with HP. The main outcome measures were improvement in ODS, recurrence of rectocele, complications and dyspareunia. Results:The trial included 40 female patients with anterior rectocele. There was no significant difference between the two groups regarding the postoperative Wexner score.Complete cure and significant improvement in ODS symptoms were comparable after the two techniques. The reduction in rectocele size after HP was significantly greater than after VP (1.7 vs. 2.6, P < 0.0001). Significant improvement in dyspareunia was recorded after HP (P = 0.001) but not after VP (P = 0.1). There was no significant difference between the two groups with regard to operating time, complications and recurrence. Conclusion:VP and HP of the rectovaginal septum in TPR were associated with a comparable improvement in ODS symptoms and similar complication rates. HP was followed by a greater reduction in the rectocele size and greater improvement in dyspareunia than VP.

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Section: Discussionsupporting

confidence: 86%

Horizontal versus vertical plication of the rectovaginal septum in transperineal repair of anterior rectocele: a pilot randomized clinical trial

et al. 2020

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“…The median rate of postoperative improvement in ODS symptoms was 72.7% (range, 45.8%-83.3%)[ 23 - 31 ]. More specifically, a significant decline in the symptom score used to measure ODS symptoms ranged from 54.8%-78.0%[ 23 , 24 , 27 , 28 ]. The studies that used fluoroscopic defecography for assessment reported a reduction in rectocele depth ranging from 41.4%-95.0%[ 23 - 25 , 27 , 31 ].…”

Section: Resultsmentioning

confidence: 99%

“…In contrast, Ayabaca et al [ 30 ] reported a non-significant decline in the MRP and maximum squeeze pressure after repair. Two studies reported a significant decrease in the threshold of rectal sensation after TPR[ 24 , 27 ].…”

Section: Resultsmentioning

confidence: 99%

Literature review of the outcome of and methods used to improve transperineal repair of rectocele

Fathy¹,

Elfallal²,

Emile³

2021

WJGS

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BACKGROUND Rectocele is commonly seen in parous women and sometimes associated with symptoms of obstructed defecation syndrome (ODS). AIM To assess the current literature in regard to the outcome of the classical transperineal repair (TPR) of rectocele and its technical modifications. METHODS An organized literature search for studies that assessed the outcome of TPR of rectocele was performed. PubMed/Medline and Google Scholar were queried in the period of January 1991 through December 2020. The main outcome measures were improvement in ODS symptoms, improvement in sexual functions and continence, changes in manometric parameters, and quality of life. RESULTS After screening of 306 studies, 24 articles were found eligible for inclusion to the review. Nine studies (301 patients) assessed the classical TPR of rectocele. The median rate of postoperative improvement in ODS symptoms was 72.7% (range, 45.8%-83.3%) and reduction in rectocele size ranged from 41.4%-95.0%. Modifications of the classical repair entailed omission of levatorplasty, addition of implant, concomitant lateral internal sphincterotomy, changing the direction of plication of rectovaginal septum, and site-specific repair. CONCLUSION The transperineal repair of rectocele is associated with satisfactory, yet variable, improvement in ODS symptoms with parallel increase in quality-of-life score. Several modifications of the classical TPR were described. These modifications include omission of levatorplasty, insertion of implants, performing lateral sphincterotomy, changing the direction of classical plication, and site-specific repair. The indications for these modifications are not yet fully clear and need further prospective studies to help tailor the technique to rectocele patients.

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“…13 Failure of symptoms improvement after transperineal repair may be attributable to inadequate plication of the rectal wall or development of hypertensive anal canal postoperatively, as suggested in a recent study. 15 Although several technical modifications/additions to improve the outcome of TPR have been described, there is no consensus on the optimal indications for each modification. 22 Although a significant improvement in the ODS symptoms was reported by the majority of patients, almost one-quarter of patients complained of persistent symptoms and lack of satisfactory improvement after surgery.…”

Section: Discussionmentioning

confidence: 99%

“…The significant improvement in symptoms of ODS was defined as the reduction in the preoperative Wexner score by 25% or more after surgical repair, as reported in other studies. 14 15…”

Section: Methodsmentioning

confidence: 99%

Higher Symptom Score, Larger Residual Rectocele, and Lower Rectal Compliance Predict Failure of Improvement after Surgical Treatment of Rectocele

Emile

Elfallal

Abdelnaby

et al. 2022

Journal of Coloproctology

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Background Rectocele is a frequent finding in women and is usually asymptomatic. However, it is sometimes associated with symptoms of obstructed defecation syndrome (ODS). While most patients with ODS due to rectocele respond well to conservative treatment, some may require surgical treatment. The aim of the study was to determine the predictors of failure of symptom improvement after rectocele repair. Methods The study included adult women with rectocele who underwent surgical treatment by transperineal repair (TPR) or transvaginal repair (TVR). The preoperative and postoperative assessment was done using the Wexner constipation score, anorectal manometry, and defecography. Results A total of 93 female patients with a mean age of 43.7 years were included. Among them, 65.6% of patients underwent TPR and 34.4% underwent TVR; 22 (23.7%) patients reported failure of significant improvement in ODS symptoms after surgery. The independent predictors of failure of improvement were higher preoperative Wexner score (odds ratio, OR: 1.4, 95% confidence interval, CI: 1.09–1.84, p = 0.009), larger residual rectocele after repair (OR: 2.95, 95% CI: 1.43–6.08, p = 0.003), and lower postoperative maximum tolerable volume (OR: 0.949, 95% CI: 0.907–0.992, p = 0.02). The predictive cutoff point for the preoperative Wexner score was 15. Conclusions Patients with a preoperative Wexner score higher than 15 and larger residual rectocele after surgery may experience little improvement in symptoms after rectocele repair. Although TPR was associated with a poorer relief of symptoms than did TVR; it was not an independent predictor of failure.

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Specific Changes in Manometric Parameters are Associated with Non-improvement in Symptoms after Rectocele Repair

Cited by 7 publications

References 18 publications

Horizontal versus vertical plication of the rectovaginal septum in transperineal repair of anterior rectocele: a pilot randomized clinical trial

Horizontal versus vertical plication of the rectovaginal septum in transperineal repair of anterior rectocele: a pilot randomized clinical trial

Literature review of the outcome of and methods used to improve transperineal repair of rectocele

Higher Symptom Score, Larger Residual Rectocele, and Lower Rectal Compliance Predict Failure of Improvement after Surgical Treatment of Rectocele

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