Surgical Correction of Rectocele Via Transvaginal Access: Optimization Option, Immediate and Long-Term Outcomes

Introduction. The transvaginal technique with application of patient's proper tissues is considered the most suitable for the surgical correction of the lower and middle rectocele. However, despite the complete anatomical correction, functional results are not satisfactory in 7-20% of patients.
The aim of the study was to improve functional results of surgical treatment of rectocele via transvaginal access.
Materials and methods. The study included 45 female patients who were randomly divided into two groups. In the control group, patients underwent posterior colporrhaphy and anterior levatorplasty using the conventional technique. In patients of the main group the operation was performed with the creation of the connective tissue layer between the levator ani muscles. The results of treatment were clinically assessed immediately after surgery, in one year and in 3 years after surgery by performing defecography and anorectal functional tests.
Results. According to a ten-point scale the pain syndrome was 3.6±0.8 points in the main group and 4.1±0.7 points in the control group (P=0,639). No purulent complications were observed in patients. Defecography evidenced that in patients of both groups, rectocele correction was achieved after a year and corresponded to stage 0-I in 3 years, the results achieved were preserved in most patients. The rate of barium evacuation approached the norm and was 5.3±0.7 g/sec in the main group and 5.2±0.6 g/sec in the control group (P=0,913), in 3 years - 5.4±0.6 g/sec and 5.1±0.5 g/sec (P=0,701), respectively. According to the study terms, there were almost normal parameters of the residual volume of barium after emptying in both groups: 18.5±5.2% and 21.6±5.5% (P=0,683) and 19.1±5.3% and 21.1±4.1% (P=0,766). Evaluation of the reflex function of the rectum demonstrated an improvement in its sensitivity to small volumes of filling and a decrease in the volumes that cause the urge to defecate in the main and control groups, which persisted over the long-term follow-up. 18 patients of the control group noted a feeling of discomfort in the perineum during the first year after surgery and dyspareunia. In 3 years, 10 out of 18 patients noted a feeling of discomfort, dyspareunia persisted in 8 of them. The patients of the main group did not make these complaints.
Conclusions. The proposed method of rectocele correction with the creation of the connective tissue layer between the muscles allowed the authors to avoid negative effects with simultaneous restoration of normal anatomical and defecatory function.