Functional results after surgery for obstructed defecation

Obstructed defecation (OD) syndrome is associated with several abnormalities of the pelvic organs, namely anterior rectal mucosa prolapse, anterior rectocele, recto-anal intussusception, and a deep Douglas pouch which predisposes to enterocele or rectocele. Surgical repair of the anatomical deformities should be attempted, only after thorough selection of patients and conservative treatment has been exhausted. Transperineal procedures include resection-plication of the anterior rectal wall and stapled transanal rectal resection, and are indicated for the treatment of anterior rectocele and internal rectal prolapse. Functional results are satisfactory in approximately 75 percent of the cases. Transabdominal procedures include posterior prosthesis rectopexy, resection suture-rectopexy and ventral prosthesis colporectopexy. These procedures are indicated in patients with large rectocele and rectal intussusception and enterocele or sigmoidocele. The rate of repair of anatomical deformities is very high and improvement of symptoms is accounted in more than 80 percent of the cases. Ventral prosthesis colporectopexy seems a very promising approach, but further evidence is mandatory.