Higher Symptom Score, Larger Residual Rectocele, and Lower Rectal Compliance Predict Failure of Improvement after Surgical Treatment of Rectocele
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 a...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Thieme Revinter Publicações Ltda.
2022-09-01
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| Series: | Journal of Coloproctology |
| Subjects: | |
| Online Access: | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0042-1756146 |
| _version_ | 1798035456019922944 |
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| author | Sameh Hany Emile Ahmed Hossam Elfallal Mahmoud Abdelnaby Mohamed Balata |
| author_facet | Sameh Hany Emile Ahmed Hossam Elfallal Mahmoud Abdelnaby Mohamed Balata |
| author_sort | Sameh Hany Emile |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-04-11T20:58:31Z |
| format | Article |
| id | doaj.art-9bf1ac4ff50748179f7457268f04d104 |
| institution | Directory Open Access Journal |
| issn | 2237-9363 2317-6423 |
| language | English |
| last_indexed | 2024-04-11T20:58:31Z |
| publishDate | 2022-09-01 |
| publisher | Thieme Revinter Publicações Ltda. |
| record_format | Article |
| series | Journal of Coloproctology |
| spelling | doaj.art-9bf1ac4ff50748179f7457268f04d1042022-12-22T04:03:36ZengThieme Revinter Publicações Ltda.Journal of Coloproctology2237-93632317-64232022-09-01420324525010.1055/s-0042-1756146Higher Symptom Score, Larger Residual Rectocele, and Lower Rectal Compliance Predict Failure of Improvement after Surgical Treatment of RectoceleSameh Hany Emile0Ahmed Hossam Elfallal1Mahmoud Abdelnaby2Mohamed Balata3Division of Colorectal Surgery, Department of General Surgery, Mansoura University Hospitals, Mansoura University, Mansoura, Egypt.Division of Colorectal Surgery, Department of General Surgery, Mansoura University Hospitals, Mansoura University, Mansoura, Egypt.Division of Colorectal Surgery, Department of General Surgery, Mansoura University Hospitals, Mansoura University, Mansoura, Egypt.Division of Colorectal Surgery, Department of General Surgery, Mansoura University Hospitals, Mansoura University, Mansoura, Egypt.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.http://www.thieme-connect.de/DOI/DOI?10.1055/s-0042-1756146rectocelerepairpredictorsoutcomeventral mesh rectopexy |
| spellingShingle | Sameh Hany Emile Ahmed Hossam Elfallal Mahmoud Abdelnaby Mohamed Balata Higher Symptom Score, Larger Residual Rectocele, and Lower Rectal Compliance Predict Failure of Improvement after Surgical Treatment of Rectocele Journal of Coloproctology rectocele repair predictors outcome ventral mesh rectopexy |
| title | Higher Symptom Score, Larger Residual Rectocele, and Lower Rectal Compliance Predict Failure of Improvement after Surgical Treatment of Rectocele |
| title_full | Higher Symptom Score, Larger Residual Rectocele, and Lower Rectal Compliance Predict Failure of Improvement after Surgical Treatment of Rectocele |
| title_fullStr | Higher Symptom Score, Larger Residual Rectocele, and Lower Rectal Compliance Predict Failure of Improvement after Surgical Treatment of Rectocele |
| title_full_unstemmed | Higher Symptom Score, Larger Residual Rectocele, and Lower Rectal Compliance Predict Failure of Improvement after Surgical Treatment of Rectocele |
| title_short | Higher Symptom Score, Larger Residual Rectocele, and Lower Rectal Compliance Predict Failure of Improvement after Surgical Treatment of Rectocele |
| title_sort | higher symptom score larger residual rectocele and lower rectal compliance predict failure of improvement after surgical treatment of rectocele |
| topic | rectocele repair predictors outcome ventral mesh rectopexy |
| url | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0042-1756146 |
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