AIM OF THIS STUDY: to compare the outcomes of two techniques for transvaginal rectocele repair. METHODS: 180 patients with III grade symptomatic rectocele were enrolled in a prospective, randomized study from January 2005 to December 2010. After clinical evaluation, patients were randomly alternatively allocated to 2 treatment groups. 90 were treated with Perineal Body Anchorage (PBA) of posterior septum (A-group) and 90 underwent Traditional Denonvilliers’ Transversal Suture after removing vaginal posterior skin (TDTS) (B-group). There were 5 dropouts from follow-up, among them 3 (90-3=87) in the former and 2 (90-2=88) in the latter. Intussusception or non-relaxing puborectalis syndrome were ruled out. The mean follow-up was 22 months (range 9 - 72 months). Comparisons of group means were performed with “t student” test for independent samples. Proportions were compared with chi-square test (χ2). A logistic regression analysis was performed to control for covariates that differed in our two groups despite randomization. The quality of life was assessed by specific (Pelvic Floor Distress Inventory (PFDI), Pelvic Floor Impact Questionnaire (PFIQ), Wexner score, Sexuality score) and aspecific tests (Locus of Control of Behaviour (LCB), VAS score). POP-Q (Pelvic Organs Prolapse Quantification) was used for evaluation of prolapse. PERINEAL BODY ANCHORAGE (PBA), TRADITIONAL DENONVILLIERS' TRANSVERSAL SUTURE (TDTS) RESULTS: The study groups were comparable in terms of demographic factors and rectocele-related symptoms and signs. A-group: 61 (70.1%) patients were compelled to digitally assisted rectal emptying; according to POP-Q score the mean Ap value was 2.2 ±1.8 and Bp value was 4.9 ± 2.3. B-group: 59 (67%) patients were compelled to digitally assisted rectal emptying; the mean Ap value was 2.3 ±1.7 and Bp value was 4.8 ± 2.1. In the follow-up A-group POP-Q Ap value mean was -2.0 ± 1.0 (t student=19.11; p<0.001) and Bp value was -2.5 ± 0.5 (t student = 29.49; p<0.001;); B-group POP-Q Ap value mean was -1.9 ± 2.1 (t student=14.53; p<0.001) and Bp value was -2.1 ± 0.9 (t student = 28.31; p<0.001). 81 (93.1%) patients in A-group and 76 (86.3%) in B-group reported improvement in symptoms (P =0.222) after the operation. Need to digitally assisted rectal emptying decreased significantly in both groups, to 4 (4.6%) for the A-group and 3 (3.4%) for the B-group. The respective recurrence rates of rectocele were 5 (5.7%) vs. 6 (6.8%) (P = 0,984). Defecography (made in 50 patients among A-group and in 47 among B-group) showed a significant decrease in rectocele depth. Quality of life was significantly improved in both groups. CONCLUSION: Both operative techniques are effective to solve anatomic posterior compartment defect and to improve the functional symptoms. The anchorage to the perineal body was associated with less clinically diagnosed recurrences of rectocele, but the difference was not statistically significant. Both techniques improve the quality of life.
TWO VAGINAL TECHNIQUES FOR RECTOCELE REPAIR: A COMPARATIVE STUDY.
LEANZA, Vito;
2011-01-01
Abstract
AIM OF THIS STUDY: to compare the outcomes of two techniques for transvaginal rectocele repair. METHODS: 180 patients with III grade symptomatic rectocele were enrolled in a prospective, randomized study from January 2005 to December 2010. After clinical evaluation, patients were randomly alternatively allocated to 2 treatment groups. 90 were treated with Perineal Body Anchorage (PBA) of posterior septum (A-group) and 90 underwent Traditional Denonvilliers’ Transversal Suture after removing vaginal posterior skin (TDTS) (B-group). There were 5 dropouts from follow-up, among them 3 (90-3=87) in the former and 2 (90-2=88) in the latter. Intussusception or non-relaxing puborectalis syndrome were ruled out. The mean follow-up was 22 months (range 9 - 72 months). Comparisons of group means were performed with “t student” test for independent samples. Proportions were compared with chi-square test (χ2). A logistic regression analysis was performed to control for covariates that differed in our two groups despite randomization. The quality of life was assessed by specific (Pelvic Floor Distress Inventory (PFDI), Pelvic Floor Impact Questionnaire (PFIQ), Wexner score, Sexuality score) and aspecific tests (Locus of Control of Behaviour (LCB), VAS score). POP-Q (Pelvic Organs Prolapse Quantification) was used for evaluation of prolapse. PERINEAL BODY ANCHORAGE (PBA), TRADITIONAL DENONVILLIERS' TRANSVERSAL SUTURE (TDTS) RESULTS: The study groups were comparable in terms of demographic factors and rectocele-related symptoms and signs. A-group: 61 (70.1%) patients were compelled to digitally assisted rectal emptying; according to POP-Q score the mean Ap value was 2.2 ±1.8 and Bp value was 4.9 ± 2.3. B-group: 59 (67%) patients were compelled to digitally assisted rectal emptying; the mean Ap value was 2.3 ±1.7 and Bp value was 4.8 ± 2.1. In the follow-up A-group POP-Q Ap value mean was -2.0 ± 1.0 (t student=19.11; p<0.001) and Bp value was -2.5 ± 0.5 (t student = 29.49; p<0.001;); B-group POP-Q Ap value mean was -1.9 ± 2.1 (t student=14.53; p<0.001) and Bp value was -2.1 ± 0.9 (t student = 28.31; p<0.001). 81 (93.1%) patients in A-group and 76 (86.3%) in B-group reported improvement in symptoms (P =0.222) after the operation. Need to digitally assisted rectal emptying decreased significantly in both groups, to 4 (4.6%) for the A-group and 3 (3.4%) for the B-group. The respective recurrence rates of rectocele were 5 (5.7%) vs. 6 (6.8%) (P = 0,984). Defecography (made in 50 patients among A-group and in 47 among B-group) showed a significant decrease in rectocele depth. Quality of life was significantly improved in both groups. CONCLUSION: Both operative techniques are effective to solve anatomic posterior compartment defect and to improve the functional symptoms. The anchorage to the perineal body was associated with less clinically diagnosed recurrences of rectocele, but the difference was not statistically significant. Both techniques improve the quality of life.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
