Surgical Treatment for Rectocele by Posterior Colporrhaphy Compared to Stapled Transanal Rectal Resection
Background: Rectocele is defined as a defect in the rectovaginal septum, causing symptoms like obstructed defecation syndrome (ODS), vaginal bulging, etc. Once the rectocele is larger than 3 cm and/or symptomatic, surgery should be considered. The surgical approach can be either transvaginal, transa...
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MDPI AG
2023-01-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/12/2/678 |
| _version_ | 1797440562262966272 |
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| author | Ohad Gluck Doraid Matani Ada Rosen Elad Barber Eran Weiner Shimon Ginath |
| author_facet | Ohad Gluck Doraid Matani Ada Rosen Elad Barber Eran Weiner Shimon Ginath |
| author_sort | Ohad Gluck |
| collection | DOAJ |
| description | Background: Rectocele is defined as a defect in the rectovaginal septum, causing symptoms like obstructed defecation syndrome (ODS), vaginal bulging, etc. Once the rectocele is larger than 3 cm and/or symptomatic, surgery should be considered. The surgical approach can be either transvaginal, transanal or transperineal. Two of the most common procedures in treating rectocele are posterior colporrhaphy (PC) and stapled trans anal rectal resection (STARR). The purpose of this study was to compare surgical outcomes of both procedures. Methods: This is a retrospective cohort study. Included were patients of the age of 18–85 years that underwent either STARR (n = 49 patients) or PC (n = 24 patients) procedures after a full clinical (defecography and physical exam before and after the surgery) and physiologic (a detailed questionnaire before and after the surgery) surveys. Symptoms of ODS before and after surgery were evaluated by questioners. Results: Preoperatively, the patients in the STARR group had significantly higher rates of ODS: straining (90.9% vs. 65.2%), incomplete evacuation (100% vs. 69.6%), hard stool (57.8% vs. 43.5%), sense of obstruction (76.1% vs. 56.5%), and use of digitation (64.4% vs. 47.8%), or laxatives (70% vs. 47.8%), <i>p</i> < 0.001. Anatomically, the mean rectocele size was smaller for the STARR group, compared to the PC group (3.8 ± 1.4 vs. 5.3 ± 2.2 cm, respectively, <i>p</i> < 0.001). Postoperatively, in the STARR group, higher rates of patients complained about straining (36.4% vs. 21.7%, <i>p</i> < 0.001) and use of digitation (64.4% vs. 26.1%, <i>p</i> < 0.001), whereas lower rates of patients complained about incomplete evacuation (41.2% vs. 56.5%, <i>p</i> = 0.05) and sense of obstruction (17.6%, vs. 34.8%, <i>p</i> = 0.03), compared to the PC group. Among patients who underwent the STARR procedure, a decrease in rates of all symptoms was noted (straining 54.5%, incomplete evacuation 58.8%, hard stool 29.2%, sense of obstruction 58.5%, use of digitation 0.1%, and use of laxatives 31.5%). Both procedures are effective in reducing rectocele size (STARR- 1.9 ± 1 cm, PC- 3.1 ± 1). Conclusions: Both STARR and PC are effective in treating rectocele. It seems that the STARR procedure is superior to the PC procedure in treating symptoms of ODS. |
| first_indexed | 2024-03-09T12:09:58Z |
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| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-09T12:09:58Z |
| publishDate | 2023-01-01 |
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| spelling | doaj.art-c66ceac9ace64c73a51e8abdb00c95692023-11-30T22:53:21ZengMDPI AGJournal of Clinical Medicine2077-03832023-01-0112267810.3390/jcm12020678Surgical Treatment for Rectocele by Posterior Colporrhaphy Compared to Stapled Transanal Rectal ResectionOhad Gluck0Doraid Matani1Ada Rosen2Elad Barber3Eran Weiner4Shimon Ginath5Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon 58100, IsraelSackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, IsraelSackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, IsraelDepartment of Obstetrics and Gynecology, Wolfson Medical Center, Holon 58100, IsraelDepartment of Obstetrics and Gynecology, Wolfson Medical Center, Holon 58100, IsraelDepartment of Obstetrics and Gynecology, Wolfson Medical Center, Holon 58100, IsraelBackground: Rectocele is defined as a defect in the rectovaginal septum, causing symptoms like obstructed defecation syndrome (ODS), vaginal bulging, etc. Once the rectocele is larger than 3 cm and/or symptomatic, surgery should be considered. The surgical approach can be either transvaginal, transanal or transperineal. Two of the most common procedures in treating rectocele are posterior colporrhaphy (PC) and stapled trans anal rectal resection (STARR). The purpose of this study was to compare surgical outcomes of both procedures. Methods: This is a retrospective cohort study. Included were patients of the age of 18–85 years that underwent either STARR (n = 49 patients) or PC (n = 24 patients) procedures after a full clinical (defecography and physical exam before and after the surgery) and physiologic (a detailed questionnaire before and after the surgery) surveys. Symptoms of ODS before and after surgery were evaluated by questioners. Results: Preoperatively, the patients in the STARR group had significantly higher rates of ODS: straining (90.9% vs. 65.2%), incomplete evacuation (100% vs. 69.6%), hard stool (57.8% vs. 43.5%), sense of obstruction (76.1% vs. 56.5%), and use of digitation (64.4% vs. 47.8%), or laxatives (70% vs. 47.8%), <i>p</i> < 0.001. Anatomically, the mean rectocele size was smaller for the STARR group, compared to the PC group (3.8 ± 1.4 vs. 5.3 ± 2.2 cm, respectively, <i>p</i> < 0.001). Postoperatively, in the STARR group, higher rates of patients complained about straining (36.4% vs. 21.7%, <i>p</i> < 0.001) and use of digitation (64.4% vs. 26.1%, <i>p</i> < 0.001), whereas lower rates of patients complained about incomplete evacuation (41.2% vs. 56.5%, <i>p</i> = 0.05) and sense of obstruction (17.6%, vs. 34.8%, <i>p</i> = 0.03), compared to the PC group. Among patients who underwent the STARR procedure, a decrease in rates of all symptoms was noted (straining 54.5%, incomplete evacuation 58.8%, hard stool 29.2%, sense of obstruction 58.5%, use of digitation 0.1%, and use of laxatives 31.5%). Both procedures are effective in reducing rectocele size (STARR- 1.9 ± 1 cm, PC- 3.1 ± 1). Conclusions: Both STARR and PC are effective in treating rectocele. It seems that the STARR procedure is superior to the PC procedure in treating symptoms of ODS.https://www.mdpi.com/2077-0383/12/2/678rectoceleobstructed defecation syndromecolporrhaphy |
| spellingShingle | Ohad Gluck Doraid Matani Ada Rosen Elad Barber Eran Weiner Shimon Ginath Surgical Treatment for Rectocele by Posterior Colporrhaphy Compared to Stapled Transanal Rectal Resection Journal of Clinical Medicine rectocele obstructed defecation syndrome colporrhaphy |
| title | Surgical Treatment for Rectocele by Posterior Colporrhaphy Compared to Stapled Transanal Rectal Resection |
| title_full | Surgical Treatment for Rectocele by Posterior Colporrhaphy Compared to Stapled Transanal Rectal Resection |
| title_fullStr | Surgical Treatment for Rectocele by Posterior Colporrhaphy Compared to Stapled Transanal Rectal Resection |
| title_full_unstemmed | Surgical Treatment for Rectocele by Posterior Colporrhaphy Compared to Stapled Transanal Rectal Resection |
| title_short | Surgical Treatment for Rectocele by Posterior Colporrhaphy Compared to Stapled Transanal Rectal Resection |
| title_sort | surgical treatment for rectocele by posterior colporrhaphy compared to stapled transanal rectal resection |
| topic | rectocele obstructed defecation syndrome colporrhaphy |
| url | https://www.mdpi.com/2077-0383/12/2/678 |
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