Coexistence of rectocele and anal incontinence and long term results of simultaneous surgical repair

Aim: In this study, we evaluated the coexisting prevalence of fecal incontinence and rectocele and also long-term results of the perineal repair techniques used for the management of this group of patients. Method: 297 female patients presenting to our clinic with outlet obstruction symptoms were evaluated prospectively. Coexisting pathologies of rectosele and fecal incontinence were determined in 27 patients (mean age 61). Vicryl mesh repair with a perineal approach were performed in all patients, followed by anoverlapping sphincteroplastyin 9 and levatoroplasty in 18 patients. Before and after surgery, all patients were evaluated with anal manometry pressure measurement, Cleveland Clinic Incontinance Score(CCIS), Adjusted Obstructive Defecation Score (ODSc),Cleveland ClinicConstipation Score (CCCS) and Adjusted Pelvic Floor Disorder Questionnaire (PFDI-20). Results: The mean follow-up time was 12 months. The post-operative decrease of the CCCS, CCIS and ODSc scores (14.15 vs 5.6, 9.7 vs 2.7 and 9.3 vs 3.4) were statistically significant. Although they were not statistically significant, the mean resting and squeezing pressures were found to be increased (47.11 vs 54.55 and 51.55 vs 61.7)in the anal manometry assessment.PFDI-20 also revealed a significant better quality of life in the post-operative follow-up (72.45 vs 20.83). Conclusion: In such patients, adding a levatorplasty or sphincteroplasty procedure to the mesh repair of rectosele may provide increased success rates and better patient satisfaction. Key Words: Rectocele, Anal incontinence, Surgical technique