Long-term outcomes of transanal rectocele repair.

PURPOSE: This study was designed to assess the risk of rectocele recurrence after transanal repair and identify its predictive factors.
METHODS: A series of 71 females who had undergone transanal repair of low isolated rectocele was retrospectively reviewed. The functional outcome was assessed by a standard questionnaire. The follow-up varied from 30 to 128 (mean, 74 +/- 30) months. Recurrences were evaluated by survival-analysis methods, and Cox's proportional hazar model was used to determine the optimal predictive factor for recurrence.
RESULTS: Twenty-nine of 71 patients had isolated low rectocele recurrence, and 6 had a rectocele recurrence associated to an enterocele occurrence. The optimal predictive factor for rectocele recurrence was the persistence of symptoms two months after surgery. Although correlated to recurrences, preoperative manual pressure during defecation was not an independent predictive factor for recurrences. Preoperative defecographic parameters do not seem to influence clinical outcome of surgery, and preoperative manometric values did not determine which females could develop anal incontinence several years after surgery.
CONCLUSIONS: The results of the transanal rectocele repair might progressively be worse during the length of the follow-up with a high recurrence rate (50 percent). Preoperative clinic, defecographic, or manometric parameters are not useful to identify females at risk for recurrence.