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CC BY-NC-ND 4.0 · Journal of Coloproctology 2022; 42(03): 245-250
DOI: 10.1055/s-0042-1756146
Original Article

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

Sameh Hany Emile 
1   Division of Colorectal Surgery, Department of General Surgery, Mansoura University Hospitals, Mansoura University, Mansoura, Egypt.
,
Ahmed Hossam Elfallal 
1   Division of Colorectal Surgery, Department of General Surgery, Mansoura University Hospitals, Mansoura University, Mansoura, Egypt.
,
Mahmoud Abdelnaby
1   Division of Colorectal Surgery, Department of General Surgery, Mansoura University Hospitals, Mansoura University, Mansoura, Egypt.
,
Mohamed Balata
1   Division of Colorectal Surgery, Department of General Surgery, Mansoura University Hospitals, Mansoura University, Mansoura, Egypt.
› Author Affiliations Funding The authors have no sources of funding or support to declare.
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Abstract

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.

Keywords

rectocele - repair - predictors - outcome - ventral mesh rectopexy

Author Contributions

Sameh Emile designed the study, and contributed to data collection, analysis, and writing of the manuscript. Ahmed Elfallal contributed to data collection, analysis, and writing parts of the manuscript. Mahmud Abdelnaby and Mohamed Balata contributed to data collection, drafting, and critical revision of the manuscript.




Publication History

Received: 20 April 2022

Accepted: 01 August 2022

Article published online:
20 September 2022

© 2022. Sociedade Brasileira de Coloproctologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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