Surgical rectocele repair – many techniques, few unambiguous conclusions
Authors:
P. Ihnát 1,2; P. Jelínek 2; P. Guňková 1,2; L. Martínek 1,2
; P. Vávra 1,2; P. Zonča
Authors place of work:
Katedra chirurgických oborů, Lékařská fakulta Ostravské univerzity
vedoucí katedry: Doc. MUDr. P. Zonča, PhD., FRCS
1; Chirurgická klinika, FN Ostrava, přednosta: Doc. MUDr. P. Zonča, PhD., FRCS
2
Published in the journal:
Rozhl. Chir., 2014, roč. 93, č. 4, s. 188-193.
Category:
Review
Summary
Introduction:
Surgical treatment of rectocele represents a controversial issue on the boundary between medical specialisations with many different corrective surgical techniques. Is it possible, based on the available knowledge, to determine an optimal operative technique for rectocele repair?
Methods:
Complex literature search focusing on the identification of rectocele surgical repair studies in the MEDLINE, PubMed and Google Scholar databases. The aim of this paper is to offer a comprehensive review of the contemporary situation as regards rectocele surgical repair.
Results:
There are four main possible approaches for rectocele repair – transvaginal, transanal, transperineal and transabdominal.
Posterior colporrhaphy with levatoroplasty is the traditional transvaginal technique, performed at most gynaecological departments in various modifications. Defect-specific rectocele repair and mesh repair represent newer transvaginal techniques which offer better postoperative functional results, although with the risk of possible serious complications.
Traditional transanal rectocele repair (vertical and horizontal plication of the rectovaginal septum) is currently performed only rarely due to its worse results in comparison with the transvaginal approach. Rectal resection using endostaplers (STARR and TRANSTAR techniques) is a modern transanal technique. Stapled rectocele repair leads to the correction of anorectal anatomical conditions and to the improvement of obstructive defecation symptoms with acceptable morbidity.
Transperineal approach is usually used in patients with rectocele and anal incontinence due to a proven sphincter defect. Transabdominal laparoscopic approach is based on vaginorectopexy by means of mesh implantation, and it is indicated especially in patients with rectocele and enterocele.
Conclusion:
Based on the results of published studies, it is not possible to determine clear guidelines for rectocele surgical repair. Posterior colporrhaphy and stapled transanal repair are the most common techniques in practice. Prospective randomized studies focusing on the comparison between transvaginal and stapled transanal approach for rectocele repair are needed.
Key words:
rectocele – operative techniques – pelvic floor disorders –obstructive defecation syndrome
Zdroje
1. Lehur PA, Meurette G. Defaecation disorders. In Herold A et al. European Manual of Medicine: Coloproctology. Berlin, Springer 2008:105–120.
2. Talley NJ, Weaver AL, Zinsmeister AR, Melton LJ. Functional constipation and outlet delay: a population-based study. Gastroenterology 1993;105:781–790.
3. Peppas G, Alexiou VG, Mourtzoukou E, Falagas ME. Epidemiology of constipation in Europe and Oceania: a systematic review. BMC Gastroenterology 2008;8:5.
4. Jayne DG, Schwandner O, Stuto A. Stapled Transanal Rectal Resection for Obstructed Defecation Syndrome: one-year results of the European STARR Registry. Dis Colon Rectum 2009;52:1205–1214.
5. Zbar AP, Lienemann A, Fritsch H, Beer-Gabel M, Pescatori M. Rectocele: pathogenesis and surgical management. Int J Colorectal Dis 2003;18:369–384.
6. Lefevre R, Davila GW. Functional Disorders: Rectocele. Clin Colon Rectal Surg 2008;21:129–137.
7. Maslekar S, Jayne DG. The Management of Constipation. In: Brown SR et al. Contemporary Coloproctology. London, Springer 2012:399–406.
8. Goh JTW, Tjandra JJ, Carey MP. How could management of rectoceles be optimized? ANZ J Surg 2002;72:896–901.
9. Davila GW, Ghoniem GM, Kapoor DS, Contreras-Ortiz O. Pelvic floor dysfunction management practice patterns: a survey of members of the international urogynecological association. Int Urogynecol J 2002;13:319–325.
10. Nichols DH. Posterior colporrhaphy and perineorrhaphy: separate and distinct operations. Am J Obstat Gynecol 1991;164: 714–721.
11. Beck DE, Allen NL. Rectocele. Clin Colon Rectal Surg 2010;23:90–98.
12. Ternent CA, Bastawrous AL, Morin NA, Ellis CN, Hyman NH, et al. Practice parameters for the evaluation and management of constipation. Dis Colon Rectum 2007;50:2013–2022.
13. Watson SJ, Loder PB, Halligan S, Bartram CI, Kamm MA, et al. Transperineal repair of symptomatic rectocele with Marlex mesh: A clinical, physiological and radiologic assessment of treatment. J Am Coll Surg 1996;183:257–261.
14. Goh JTW, DwyerPL. Effectiveness and safety of polypropylene mesh in vaginal prolapse surgery. Int Urogynecol J 2001;12:90–93.
15. Ayabaca SM, Zbar AP, Pescatori M. Anal continence after rectocele repair. Dis Colon Rectum 2002;45:63–69.
16. Redding MD. The relaxed perineum and anorectal disease. Dis Colon Rectum 1965;8:279–282.
17. Marks MM. The rectal side of the rectocele. Dis Colon Rectum 1967;10:387–8.
18. Sullivan ES, Leaverton GH, Hardwick CE. Transrectal perineal repair: an adjunct to improved function after anorectal surgery. Dis Coloon Rectum 1968;11:106–114.
19. Khubchandani IT, Clancy III JP, Rosen L, Riether RD, Stasik JJ. Endorectal repair of rectocele revisited. British Journal of Surgery 1997;84:89–91.
20. Sehapayak S. Transrectal repair of rectocele: an extended armamentarium of colorectal surgeons. Dis Colon Rectum 1985;6: 422–433.
21. Boccasanta P, Venturi M, Salamina G, Cesana BM. New trends in the surgical treatment of outlet obstruction: clinical and functional results of two novel transanal stapled techniques from a randomized controlled trial. Int J Colorectal Dis 2004;19:359–369.
22. Renzi A, Talento P, Giardiello C, Angelone G, Izzo D, et al. Stapled trans-anal rectal resection (STARR) by a new dedicated device for the surgical treatment of obstructed defaecation syndrome caused by rectal intussusception and rectocele: early results of a multicenter prospective study. Int J Colorectal Dis 2008;23: 999–1005.
23. Lenisa L, Schwandner O, Stuto A, Jayne D, Pigot F, et al. STARR with Contour Transtar: prospective multicentre european study. Colorectal Dis 2009;11:821–827.
24. Boccasanta P, Venturi M, Stuto A, Bottini C, Caviglia A, et al. Stapled transanal rectal resection for outlet obstruction: a prospective multicenter trial. Dis Colon Rectum 2004;47: 1285–1297.
25. Boccasanta P, Venturi M, Roviaro G. What is the benefit of a new stapler device in the surgical treatment of obstructed defecation? Three-year outcomes from a randomized controlled trial. Dis Colon Rectum 2011;54:77–84.
26. Lyons TL, Winer WK. Laparoscopic rectocele repair using polyglactin mesh. J Am Assoc Gynecol Laparosc 1997;4:381–384.
27. Paraiso MFR, Falcone T, Walters MD. Laparoscopic surgery for enterocele, vaginal apex prolapse and rectosele. Int Urogynecol J 1999;10:223–229.
28. Kahn MA, Rao SS, Kumar D, Fox SD. Posterior colporrhaphy is superior to the transanal repair for treatment of posterior vaginal wall prolapse. Neurourol Urodyn 1999;18:70–1.
29. Nieminen K, Laitinen J, Oksala J, Heinonen P. Transanal or vaginal approach to rectocele repair: results of a prospective randomised study. Neurourol Urodyn 2003;22:547–8.
30. Wolff K, Marti L, Beutner U, Staffen T, Lange J, el al. Functional outcome and quality of life after spatled transanal rectal resection for obstructed defecation syndrom. Dis Colon Rectum 2010;53:881–888.
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Surgery Orthopaedics Trauma surgeryČlánok vyšiel v časopise
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