Gynecologic indications for rectocele repair are more numerous compared to traditional colorectal indications because gynecologists primarily address vaginal symptoms when repairing a rectocele. Obstructive defecation symptoms are only some of the accepted indications. Preoperative evaluation typically includes only clinical assessment gained from the history and physical exam, and gynecologists rarely depend on defecography to plan a reconstructive procedure for rectocele. Overall, surgical correction success rates are quite high when using a vaginal approach for rectocele correction. Vaginal dissection results in better visualization and access to the endopelvic fascia and levator musculature, which allows for a more firm anatomic correction. Re-creation of a strong perineal body enhances the longevity of pelvic reconstructive procedures, especially rectocele repairs. In addition, maintaining rectal mucosal integrity appears to reduce the risk of postoperative infection and fistula formation. More comprehensive data collection is necessary to better understand the effect of various surgical techniques on vaginal, sexual, and defecatory symptoms.
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