Functional results after transvaginal, transperineal and transrectal correction of a symptomatic rectocele

Introduction: The aim of this study was to compare functional outcome after transvaginal, transperineal and transrectal repair of a symptomatic rectocele and to develop the ideal surgical approach. Patients and method: 28 patients (27 female, 1 male) who had undergone rectocele repair from 1996 to 2003 were analysed. Mean age was 59 years (range 30-79 years), follow-up was 24 months (range 3 to 70 months) and mean appearance of symptoms was 4 years prior to the operation (6months-32 years). Transvaginal repair was performed in 13 cases, transperineal repair in 8 cases and transrectal repair in 7 cases. Results: 24 of 28 patients (85.7 %) are satisfied with the operation-result (transvaginal 12 of 13 patients [92.3%], transperineal 7 of 8 patients [87.5%] and transrectal 5 of 7 patients [71.4%]). 25 patients (89.3%) are free of complaints or describe an evident improvement of symptoms (transvaginal 12 of 13 patients [92.3%], transperineal 7 of 8 patients [87.5%] und transrectal 6 of 7 patients [85.7%]). There is one postoperative dyspareunia. Discussion: Best treatment of a rectocele starts with patients selection. Considering pelvic floor as functional unity, concomitant urologic-gynaecologic lesions and proximal intraabdominal disturbances the appropriate surgical procedure is selected. Conclusion: Surgical approach to correct a symptomatic rectocele depends on the concomitant lesion.