Int J Colorect Dis (1995) 10:97-100 C ol6 e/al Disease 9 Springer-Verlag 1995 Does surgery resolve outlet obstruction from rectocele? A. Infantino, A. Masin, E. Melega, G. Dodi, M. Lise Clinica Chirurgica II, Universit~ degli Studi, Padova, Italy Accepted: 17 January 1995 Abstract. In order to ascertain whether plastic surgery for rectocele is of value in the treatment of outlet obstruction, a retrospective study was made of 21 women complaining of difficulty in expelling faeces: 13 patients (group A) underwent surgery with transanal longitudinal plication of the anterior rectal wall (Block's technique), and 8 patients (group B) had colpoperineoplasty which, in 2, was asso- ciated with bladder-neck suspension following the Raz- Peyrera technique for urinary incontinence. The mean fol- low-up was 24.2_+18.7 and 36.8+_17.8 months respec- tively. In 11 group A patients (80.9%) and 6 group B pa- tients (75%) cure, or an improvement, was achieved. Of the remaining 4 patients (19%), recurrent rectocele was found in 2 (one group A and one group B) and intestinal transit time tests detected colonic constipation in one group A and in one group B patient. It is concluded that surgery can resolve outlet obstruction from rectocele, but Block's technique is preferable because it is more straight- forward and easier. R~sum~. Afin de ddterminer l'utilit6 d'une correction chi- rurgicale plastique des rectoc~les dans le traitement des dysch6zies, une 6tude rdtrospective portant sur 21 femmes se plaignant de difficult6s d'exon6ration a 6t6 entreprise: 13 patientes (groupe A) ont subi une plicature longitudi- nale transanale de la paroi antdrieure du rectum (technique de Block) et 8 patients (groupe B) ont subi une colpo- p6rindoplastie associ6e chez deux malades 5 une suspen- sion du col de la vessie selon la technique de Raz-Peyrera pour incontinence urinaire. Le suivi moyen 6tait respec- tivement de 24,2_+ 18,7 et 36,8_+ 17,8 mois. Chez 11 pa- tients du groupe A (80,9%) et 6 patientes du groupe B (75 %), la gu6rison ou une amdlioration a 6t6 obtenue. Chez les autres 4 patientes (19%), une r6cidive de la rectoc~le a 6t6 observ6e 2 reprises (une fois dans chaque groupe) et une constipation d' origine colique d6montr6e par un temps de transit intestinal a 6t6 mise en 6vidence chez un mal- ade du groupe A et un malade de groupe B. Nous conclu- Correspondence to: A. Infantino, Istituto di Clinica Chirurgica 2, Via Giustiniani 2, 1-35128 Padova, Italy ons de cette 6tude que la chirurgie peut gu6rir la dysch6zie r6sultant d'une rectoc~le et que la technique de Block est pr6f6rable parce qu'elle donne de meilleurs r4sultats et est plus facile ~t r6aliser. It is widely believed that the main causes of constipation, a common complaint in western countries [1], are a low fiber diet and sedentary work. Often patients complain of difficulty in faecal expulsion, which can be caused by rec- tocele [2], although it can be found in 23 to 70% of asymp- tomatic patients [3-5] and it is diagnosed by defaeco- graphic examinations in 10 to 15% of constipated women [3]. Rectocele may cause or aggravate outlet obstruction because under propulsion from the rectum and increased intraabdominal pressure at straining, the stools are pushed into the rectocele rather than the anal canal. We have made a retrospective study to ascertain whether surgical repair of rectocele resolves or improves obstructed defaecation and whether Block's [4] technique is preferable to posterior colpoperineoplasty in such cases. Patients and methods Twenty-one women underwent surgery for second or third degree rectocele, associated with obstructed defecation, Block's technique, group A: 13 patients, mean age 58.2+9.6 years (_+SD)or colpope- rineoplasty, group B: 8 patients, mean age 58 +9.6 years, being per- formed. All patients complained of difficulty in evacuating faeces, with a need for prolonged and intense straining, even after following a high fiber diet (30 gins bran per day) and using bulk laxatives. Five patients in group A and three in group B had stress urinary inconti- nence. At physical examination, perineal descent was found in 9 pa- tients: in 4 at straining only and in the other five at rest as well as during straining (Table 1). The mean number of deliveries was 2.7 (range 1-4). Only 2 pa- tients had experienced difficulty during the explusive stage of la- bour, with lacerations in one case and the need for an episiotomy in the other.