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Site-Specific Rectocele Repair Compared With Standard Posterior Colporrhaphy

Yoram Abramov, MD^*, Sanjay Gandhi, MD^*, Roger P. Goldberg, MD, MPH^*, Sylvia M. Botros, MD^*, Christina Kwon, MD and Peter K. Sand, MD^*

From the *Evanston Continence Center, Evanston Northwestern Healthcare, Northwestern University, Feinberg School of Medicine, Evanston, Illinois; and Division of Urogynecology and Reconstructive Female Medicine, New York University School of Medicine, New York, New York.

OBJECTIVE: To compare the anatomic and functional outcomes of site-specific rectocele repair and standard posterior colporrhaphy.

METHODS: We reviewed charts of all patients who underwent repair of advanced posterior vaginal prolapse in our institution between July 1998 and June 2002 with at least 1 year of follow-up.

RESULTS: This study comprised 124 consecutive patients following site-specific rectocele repair and 183 consecutive patients following standard posterior colporrhaphy without levator ani plication. Baseline characteristics, including age, body mass index, parity, previous pelvic surgeries, and preoperative prolapse were not significantly different between the 2 study groups. Recurrence of rectocele beyond the midvaginal plane (33% versus 14%, P = .001) and beyond the hymenal ring (11% versus 4%, P = .02), recurrence of a symptomatic bulge (11% versus 4%, P = .02), and postoperative Bp point (–2.2 versus –2.7 cm, P = .001) were significantly higher after the site-specific rectocele repair. Rates of postoperative dyspareunia (16% versus 17%), constipation (37% versus 34%), and fecal incontinence (19% versus 18%) were not significantly different between the 2 study groups.

CONCLUSION: Site-specific rectocele repair is associated with higher anatomic recurrence rates and similar rates of dyspareunia and bowel symptoms than standard posterior colporrhaphy.

LEVEL OF EVIDENCE: II-3

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