Surgical Treatment of Symptomatic Low or Mid Rectocele (≥ 3 cm) Presenting Primarily with Gynecological Complaints
This protocol applies to patients with a symptomatic rectocele of at least 3 cm on straining, where the predominant complaint is gynecological — specifically, a sensation of a vaginal ball or posterior colpocele — rather than obstructive defecation syndrome (ODS).
Clinical Scenario
Intervention is warranted when a low or mid rectocele is both symptomatic and measures at least 3 cm with straining. When gynecological complaints predominate over intestinal ones, guidelines support an approach from below as first intention. If intestinal (ODS) complaints were to predominate instead, a different route would be advised.
Treatment Approach
Surgical repair via an approach from below is recommended; the appropriate specific route is determined by the individual clinical presentation and is detailed in the full protocol.
References
DOI: 10.1016/j.jviscsurg.2020.10.001
Therapeutic management should be initiated in the presence of a symptomatic rectocele, and measuring at least 3 cm with straining.
For low or medium rectocele without involvement of the other levels, an approach from below may be recommended as first intention.
In this situation, if the rectocele manifests itself mainly by gynecological complaints (sensation of a "vaginal ball"), a transperineal or transvaginal approach can be proposed.
If intestinal complaints (ODS) predominate, a transanal approach is advised.
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