Anal incontinence after transanal versus transvaginal repair of rectocele: matched pair cohort analysis
Jacqueline R Woodman, Michelle Thornton, Hannah Burns, Denis King, Kate H Moore
Gynaecologists have suggested that the use of anal retractors during transanal repair of rectocele may precipitate faecal incontinence, but little data exist. We compared the incidence of anal incontinence between transanal and transvaginal rectocele repair. A consecutive series of 45 patients who underwent transanal rectocele repair were matched for age (+/- 3 yrs), parity and duration of follow-up (+/- 2 yrs) and compared to a series of 45 women who had undergone transvaginal repair. A modified Wexner questionnaire was used to measure anal incontinence. Comparing gynaecological and colorectal patients, the median age (62 years, interquartile range [IQR] 50-71 vs 56, IQR = 46-66) and median follow-up (6 years, IQR 4-8.5 vs 9, IQR = 5-12) did not differ significantly (p = 0.06 and p = 0.07 respectively). The Wexner score was significantly increased (p = 0.01) in the transvaginal group (median 4, IQR = 1.5-7.5 vs median 0, IQR = 0-6.5, p = 0.01). The use of anal retractors at transanal repair may be less likely to precipitate faecal incontinence than the gynaecological procedure.