Comparative Effectiveness of Transanal versus Transvaginal Surgical Approaches for Symptomatic Rectocele: A Randomized Controlled Trial (RCT) Assessing Symptomatic Relief, and Quality of Life

Background: There is always considerable controversy about the etiology, diagnosis, and management of rectocele. However, rectocele pathophysiological mechanism is promot-ed by deterioration of the connective tissue of the recto-vaginal septum, due to age, birth trauma. As regard treatment, there are many techniques, and the debate still continue about which has the best outcome. Aim of Study: To compare the effectiveness of transvaginal repair versus transanal plication repair for symptomatic recto-cele repair as regard anatomical outcome, symptomatic relief, and quality of life. Patients and Methods: 40 women who underwent a rec-tocele repair from June 2022 to June 2024. These women are divided into 2 equal groups A and B each had 20 women. Group A received a transvaginal repair, and group B received a transanal repair. Follow-up is done for at least 6 months af-ter operation, through regular visits to the out-patient clinics. Patients are followed for physical examination and assisting complications and life quality. Results: Mean operative 44.8±6.68 in group A, while it was 62.6±7.02 in group B. Mean hospital stay was 2±1.095 in group A while in group B was 3.1±0.89. (significantly in-crease in groups B). As regard intraoperative complications (bleeding, apparent sphincter or rectal injuries). The recorded intraoperative complications were 40% in group A and 45% in group B (p=0.7521). Post operative complications was signif-icantly increased in group B (transanal repair. It was in group A in 40% (8 patients), while in 75% (15 patients) of group B (p=0.0271). The most serios complications was the incon-tinence. It occurred in 5 patients (25%) in group B, while it occurred only in one patient (5%) of group A with no signifi-cant difference between both group (p=0.0803). Anal stenosis has 0% in group A and 30% (6 cases) in group B (significantly increased in group B). Also, anal fistula has incidence of 25% in group B while it did not occur in group A. Postoperative sur-gical site infection was recorded in 4 patients of group A and in 9 patients of group B. Rectovaginal fistula recorded once in group A and no incidence in group B. There was no recur-rence in group B, while there were 2 recurrences in group A. As regard quality of life after the operations, group A has 15 patients (75%) with good improvement of life quality after the operation while group B has 35% (significant improvement in group A). Mild improvement is recorded in 3 and 2 patients in group A and B respectively. Bad quality of life after operations was 2 (10%) in group A and 11 (55%) with high significant difference between them (p=0.0027). Conclusion: The transvaginal approach for rectocele re-pair is safer, with less complications especially anal inconti-nence and stenosis. The conventional transanal approach could be replaced by other stappling techniques.