Good Post-operative Results Depend on Strict Patient Selection and Strict Operative Procedure

1. Johansson C, Nilsson BY, Holmström B, Dolk A, Mellgren A. Association between rectocele and paradoxical sphincter response. Dis Colon Rectum 1992;35:503-9. 2. Rosato GO, Lumi CM, Miguel AM. Anal sphincter electromyography and pudendal nerve terminal motor latency assessment. Seminars Colon Rectal Surg 1992;3:68-74. 3. van Dam JH, Hop WC, Schouten WR. Analysis of patients with poor outcome of rectocele repair. Dis Colon Rectum 2000;43: 1556-60. Post-operative results are variable. Some rectoceles might be caused by a paradoxical puborectalis contraction leading to an outlet obstruction and to disappointing surgical results [1]. Thus, an anorectal physiologic study including anal sponge (anal plug) electromyography should be performed for excluding non-relaxing puborectalis syndrome [2]. In that case, biofeedback therapy should be applied first. A vital point for a good post-operative result is the tightness (strength) of the reconstructed rectovaginal septum even though long-term post-operative results aredisappointing [3]. A larger decrease in the rectocele diameter means greater strength of the rectovaginal septum.