{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T01:34:05Z","timestamp":1791250445956,"version":"4.1.0"},"reference-count":10,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2023,1,15]],"date-time":"2023-01-15T00:00:00Z","timestamp":1673740800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Rectocele is defined as a defect in the rectovaginal septum, causing symptoms like obstructed defecation syndrome (ODS), vaginal bulging, etc. Once the rectocele is larger than 3 cm and\/or symptomatic, surgery should be considered. The surgical approach can be either transvaginal, transanal or transperineal. Two of the most common procedures in treating rectocele are posterior colporrhaphy (PC) and stapled trans anal rectal resection (STARR). The purpose of this study was to compare surgical outcomes of both procedures. Methods: This is a retrospective cohort study. Included were patients of the age of 18\u201385 years that underwent either STARR (n = 49 patients) or PC (n = 24 patients) procedures after a full clinical (defecography and physical exam before and after the surgery) and physiologic (a detailed questionnaire before and after the surgery) surveys. Symptoms of ODS before and after surgery were evaluated by questioners. Results: Preoperatively, the patients in the STARR group had significantly higher rates of ODS: straining (90.9% vs. 65.2%), incomplete evacuation (100% vs. 69.6%), hard stool (57.8% vs. 43.5%), sense of obstruction (76.1% vs. 56.5%), and use of digitation (64.4% vs. 47.8%), or laxatives (70% vs. 47.8%), p &lt; 0.001. Anatomically, the mean rectocele size was smaller for the STARR group, compared to the PC group (3.8 \u00b1 1.4 vs. 5.3 \u00b1 2.2 cm, respectively, p &lt; 0.001). Postoperatively, in the STARR group, higher rates of patients complained about straining (36.4% vs. 21.7%, p &lt; 0.001) and use of digitation (64.4% vs. 26.1%, p &lt; 0.001), whereas lower rates of patients complained about incomplete evacuation (41.2% vs. 56.5%, p = 0.05) and sense of obstruction (17.6%, vs. 34.8%, p = 0.03), compared to the PC group. Among patients who underwent the STARR procedure, a decrease in rates of all symptoms was noted (straining 54.5%, incomplete evacuation 58.8%, hard stool 29.2%, sense of obstruction 58.5%, use of digitation 0.1%, and use of laxatives 31.5%). Both procedures are effective in reducing rectocele size (STARR- 1.9 \u00b1 1 cm, PC- 3.1 \u00b1 1). Conclusions: Both STARR and PC are effective in treating rectocele. It seems that the STARR procedure is superior to the PC procedure in treating symptoms of ODS.<\/jats:p>","DOI":"10.3390\/jcm12020678","type":"journal-article","created":{"date-parts":[[2023,1,16]],"date-time":"2023-01-16T04:31:32Z","timestamp":1673843492000},"page":"678","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Surgical Treatment for Rectocele by Posterior Colporrhaphy Compared to Stapled Transanal Rectal Resection"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2731-6553","authenticated-orcid":false,"given":"Ohad","family":"Gluck","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon 58100, Israel"},{"name":"Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5942-405X","authenticated-orcid":false,"given":"Doraid","family":"Matani","sequence":"additional","affiliation":[{"name":"Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ada","family":"Rosen","sequence":"additional","affiliation":[{"name":"Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel"},{"name":"Proctology and Pelvic Floor Unit, Division of General Surgery, Wolfson Medical Center, Holon 58100, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8199-5692","authenticated-orcid":false,"given":"Elad","family":"Barber","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon 58100, Israel"},{"name":"Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eran","family":"Weiner","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon 58100, Israel"},{"name":"Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shimon","family":"Ginath","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon 58100, Israel"},{"name":"Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,1,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1007\/s00384-003-0478-z","article-title":"Rectocele: Pathogenesis and surgical management","volume":"18","author":"Zbar","year":"2003","journal-title":"Int. J. Color. Dis."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"773","DOI":"10.1111\/ans.14068","article-title":"Transperineal rectocele repair: A systematic review","volume":"87","author":"Zimmermann","year":"2017","journal-title":"ANZ J. Surg."},{"key":"ref_3","first-page":"869","article-title":"Risk factors associated with pelvic floor disorders in women undergoing surgical repair","volume":"101","author":"Pa","year":"2003","journal-title":"Obst. Gynecol."},{"key":"ref_4","first-page":"332","article-title":"Surgical repair of rectocele. Comparison of transvaginal","volume":"34","author":"Leanza","year":"2013","journal-title":"J. Surg."},{"key":"ref_5","unstructured":"Linardoutsos, D. (2022, June 26). Assessment and Treatment of Obstructed Defecation Syndrome. Current Topics in Faecal Incontinence. Available online: https:\/\/www.intechopen.com\/chapters\/67155."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1007\/BF02048163","article-title":"Anterior rectocele: Assessment with radiographic defecography, dynamic magnetic resonance imaging, and physical examination","volume":"37","author":"Delemarre","year":"1994","journal-title":"Dis. Colon Rectum"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1111\/j.1479-828X.2005.00486.x","article-title":"Which bowel symptoms are most strongly associated with a s rectocele?","volume":"45","author":"Dietz","year":"2005","journal-title":"Aust. N. Z. J. Obstet. Gynaecol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"zraa037","DOI":"10.1093\/bjsopen\/zraa037","article-title":"Suture rectopexy versus ventral mesh rectopexy for complete full-thickness rectal prolapse and intussusception: Systematic review and meta-analysis","volume":"5","author":"Lobb","year":"2021","journal-title":"BJS Open"},{"key":"ref_9","unstructured":"Longo, A. (2014, January 11\u201316). Obstructed defecation because of rectal pathologies. Novel surgical treatment: Stapled transanal rectal resection (STARR). Proceedings of the Annual Cleveland Clinic Florida Colorectal Disease Symposium, Ft. Lauderdale, FL, USA."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"790287","DOI":"10.3389\/fsurg.2022.790287","article-title":"Stapled Transanal Rectal Resection (Starr) in the Treatment of Obstructed Defecation: A Systematic Review","volume":"9","author":"Ripamonti","year":"2022","journal-title":"Front. Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/2\/678\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:06:25Z","timestamp":1760119585000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/2\/678"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,15]]},"references-count":10,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2023,1]]}},"alternative-id":["jcm12020678"],"URL":"https:\/\/doi.org\/10.3390\/jcm12020678","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,15]]}}}