Results of Surgical Repair

The posterior colporrhaphy has been the traditional approach to rectocele repair by gynecologists. Although commonly performed, it has been described as "among the most misunderstood and poorly performed" gynecologic sur-geries.11 Although many authors have reported satisfactory anatomic results, conflicting effects on bowel and sexual function postoperatively have been noted. Several authors have reported sexual dysfunction rates of up to 50% of women reporting dyspareunia or apareunia after posterior colporrhaphy.12

As noted, there are conflicting reports with regard to functional outcome after posterior col-porrhaphy. Importantly, many authors suggest that the significant rate of postoperative dys-pareunia may be due to the plication of the levator ani muscles, and has led to the popularization of the discrete fascial defect repair. Several authors have reported a similar anatomic cure rate with this surgery, along with significant improvement in quality of life measures. Unlike the traditional posterior colporrhaphy, all these series report less postoperative dyspareunia. The authors noted significant improvement in splinting, vaginal pressure, and stooling difficulties. However, rates of fecal incontinence and constipation were unchanged postoperatively.

These studies show promising anatomic and functional results; however, long-term prospective studies are warranted. Thus far, the incidence of postoperative dyspareunia with the discrete fascial defect repair is less than with the traditional posterior colporrhaphy. Although the above authors positively present the results of this approach to rectocele repair, other authors report skepticism about the ability to demonstrate and repair discrete fascial tears.

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