ORIGINAL ARTICLES   

Chirurgia 2002 August-October;15(4-5):135-8

Copyright © 2002 EDIZIONI MINERVA MEDICA

language: Italian

Rectocele: a comparison among different surgical techniques

Ragazzi R., Pace G., Cremona S., Vaccaro R., Di Pietro S., Buttafuoco A., Ragazzi S., Pace S.

Background. Rectocele is the protrusion of the posterior wall of the vagina and of the anterior rectal wall in the vagina; in male patients it is the protrusion of the rectum in prostatic loggia.
It is the consequence of age, malnutrition and weight loss that produce the lowering of the pelvic wall. Sometimes, it is secondary to iatrogenic nervous injuries. Symptoms are: pain, tenesmus, stipsis.
Methods. From January 1996 to April 2002, 59 patients (55 women and 4 men) underwent surgical treatment with various techniques; the mean age was 65 years (range: 42-86 years). The technique more frequently used was the transvaginal technique (35 patients, 59%), and than the Longo's operation (10 women and 2 men), and the Sullivan-Khubchandani (5 women and 1 man) and the Goldberg-Frikmann (5 women, 1 man).
Results. In 70 % of the treated patients, the results were good (absence of symptoms), in 3 patients, after a recurrence, the Golberg-Frikmann operation was performed. We prefer to use this last technique only in advanced stages because the mesorectum resection can produce impotence in man and dyspareunia in women.
Conclusions. In our opinion there is not a ''gold standard'' treatment for rectocele, but it is possible to choose among different techniques in relation to various variables such as: entity of symptoms, volume of rectocele and patient's age. The more invasive techniques, such as the Golberg-Frikmann operation, must be performed only in very serious cases.