Functional Outcome and Sexual-Related Quality of Life After Transperineal Versus Transvaginal Repair of Anterior Rectocele: A Randomized Clinical Trial

Background: Methods of treatment of rectocele include transperineal, transvaginal, and transanal approaches and ventral rectopexy. Objective: The present randomized study aimed to compare the outcome of transperineal repair and transvaginal repair of anterior rectocele. Design: This is a randomized, single-blinded clinical trial. Setting: This study was conducted at the Colorectal Surgery Unit, Mansoura University Hospitals. Patients: Adult female patients with anterior rectocele reporting obstructed defecation syndrome were selected. Interventions: Anterior rectocele was surgically treated via a transperineal or transvaginal approach. Main Outcome Measures: Improvement in constipation, operation time, hospital stay, complications, changes in anal pressures, and improvement in sexual-related quality of life was assessed by use of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire, and the incidence of dyspareunia postoperatively was assessed. Results: Sixty-four female patients of a mean age of 43.5 years were entered into the trial. There was no significant difference between the 2 groups regarding the operation time. Patients undergoing transperineal repair had significantly longer hospital stays than those undergoing transvaginal repair (2.4 vs 2.1 days, p = 0.03). There was no significant difference between the 2 groups regarding postoperative complications and recurrence of rectocele. Significant decrease in the constipation scores was recorded in both groups at 6 and 12 months after surgery. The decrease in the constipation scores after transvaginal repair was significantly higher than after transperineal repair at 6 and 12 months postoperatively. Although resting and squeeze anal pressures were significantly increased at 12 months after transperineal repair, they did not show significant change after transvaginal repair. Improvement in sexual-related quality of life was significantly higher in the transvaginal repair group than in the transperineal repair group at 6 and 12 months after surgery. Dyspareunia improved after transvaginal repair and worsened after transperineal repair, yet this change was insignificant. Limitations: This was a single-center study comprising a relatively small number of patients. Conclusion: Transvaginal repair of rectocele achieved better improvement in constipation and sexual-related quality of life than transperineal repair. Changes in dyspareunia after both techniques were not significant.