Rectocele in females: unresolved issues (review)

Among the lesions of the perineum in women, pelvic organ prolapse occupies a prominent place. One of its variants is rectocele — protrusion of the rectum wall together with the posterior vaginal wall (PVW) towards the vagina (anterior rectocele) and/or along the posterior semicircle of the intestine (posterior rectocele). Anterior rectocele (AR) is accompanied by obstructive bowel movement syndrome (OBMS) with symptoms such as pain, constipation and the need to use a finger aid during defecation. The prevalence of pelvic organ prolapse (POP) among women in some countries reaches 50%. In Russia, this figure exceeds 30%. Women of reproductive age (RA) in the context of POP and AR are of particular interest. The disease in this group is asymptomatic for a long time. A risk factor for POP in RA-women is vaginal delivery without physical rehabilitation, especially with a large fetus. An analysis of the literature indicates that operations on the posterior wall of the vagina, regardless of the technique, improve the structure of the posterior wall with a high frequency and reduce the frequency of symptomatic manifestations of AR with a lower frequency. The effectiveness of implantation of biological or synthetic grafts is not higher, and the number of potential complications, including dyspareunia and erosion of the synthetic implant, is higher. Stapler transanal resection of the rectum is associated with an improvement in the anatomy of the PVW and the resolution of OBMS after intervention. To date, there are about 300 different surgical techniques for the treatment of AR. In 2020, a working group of the International Federation of Obstetricians and Gynecologists (FIGO), analyzing the available data on the treatment of AR, concluded that a tactic involving traditional (with implication of the rectovaginal fascia) posterior colporraphy with native tissues without the use of synthetic implants is preferable. However, there is not enough data to determine the reference method of surgical treatment of AR, and the issue requires further study.

1. Achkasov S.I., Blagodarny L.A., Bojko A.V., et al. Spravochnik po koloproktologii / pod red. Ju.A. Shelygina, L.A. Blagodarnogo. M.: Litterra, 2014. 608 p. (In Russ.).

2. Guzman-Negron JM, Fascelli M, Vasavada SP. Posterior Vaginal Wall Prolapse: Suture-Based Repair. UrolClin North Am. 2019;46(1):79-85. https://doi.org/10.1016/j.ucl.2018.08.007

3. Abhyankar P, Uny I, Semple K, et al. Women's experiences of receiving care for pelvic organ prolapse: a qualitative study. BMC Womens Health. 2019;19(1):1-12. https://doi.org/10.1186/S12905-019-0741-2

4. Danilina O.A., Volkov V.G. Rasprostranennost' prolapsa tazovykh organov sredi zhenshchin reproduktivnogo vozrasta. Journal of New Medical Technologies. 2022;29(1):29-33. (In Russ.). https://doi.org/10.24412/1609-2163-2022-1-29-33

5. Orazov M.R., Radzinskij V.E., Hamoshina M.B., et al. Vzgljad na patogeneticheskie mehanizmy formirovanija prolapsa tazovyh organov. Trudnyj pacient. 2018; 16(1-2):9-15. (In Russ.).

6. Brito LGO, Pereira GMV, Moalli P, et al. Age and/or postmenopausal status as risk factors for pelvic organ prolapse development: systematic review with meta-analysis. Int Urogynecol J. 2022;33(1):15-29. https://doi.org/10.1007/s00192-021-04953-1

7. Malkhasyan V.A., Abramyan K.N. Epidemiology, pathophysiologic mechanisms and risk factors for female genital prolapse: foreign literature review. Pacific Medical Journal. 2011;1(43):9-13. (In Russ.).

8. Kuncharapu I, Majeroni BA, Johnson DW. Pelvic organ prolapse. Am Fam Physician. 20101;81(9):1111-1117.

9. Oversand SH, Staff AC, Spydslaug AE, et al. Long-term follow-up after native tissue repair for pelvic organ prolapse. International Urogynecology Journal and Pelvic Floor Dysfunction. 2014;25(1):81-89. https://doi.org/10.1007/S00192-013-2166-Z/METRICS

10. Barber MD, Maher C. Epidemiology and outcome assessment of pelvic organ prolapse. International Urogynecology Journal and Pelvic Floor Dysfunction. 2013;24(11):1783-1790. https://doi.org/10.1007/S00192-013-2169-9/METRICS

11. van den Broeck S, Jacquemyn Y, Hubens G, et al. Rectocele: victim of availability bias? Results of a Belgian survey of colorectal and gynecological surgeons. International Urogynecology Journal. 2022;33(12):3505-3517. https://doi.org/10.1007/S00192-022-05118-4

12. Kayembe AT, Muela AM, Baleka AM, et al. Genital prolapse: epidemiology, clinic and therapeutic at Saint Joseph Hospital of Kinshasa. The Pan African Medical Journal. 2020;37:1-10. https://doi.org/10.11604/PAMJ.2020.37.196.21818

13. Handa VL, Blomquist JL, Roem J, et al. Pelvic Floor Disorders after Obstetric Avulsion of the Levator Ani Muscle. Female Pelvic Medicine and Reconstructive Surgery. 2019;25(1):8-14. https://doi.org/10.1097/SPV.0000000000000644

14. Aytan H, Ertunç D, Tok EC, et al. Prevalence of pelvic organ prolapse and related factors in a general female population. Turk J Obstet Gynecol. 2014;11(3):176-180. https://doi.org/10.4274/tjod.90582

15. Milsom I, Gyhagen M. Breaking news in the prediction of pelvic floor disorders. Best Pract Res Clin Obstet Gynaecol. 2019;54:41-48. https://doi.org/10.1016/j.bpobgyn.2018.05.004

16. Gyhagen M, Bullarbo M, Nielsen TF, et al. Prevalence and risk factors for pelvic organ prolapse 20 years after childbirth: a national cohort study in singleton primiparae after vaginal or caesarean delivery. BJOG. 2013;120(2):152-160. https://doi.org/10.1111/1471-0528.12020

17. Durnea CM, O'Reilly BA, Khashan AS, et al. Status of the pelvic floor in young primiparous women. Ultrasound Obstet Gynecol. 2015;46(3):356-362. https://doi.org/10.1002/uog.14711

18. Rodríguez-Abarca MA, Hernández-Grimaldo EG, De la Fuente-Villarreal D, et al. Gynecological influencing factors on the rectovaginal septum's morphology. Int Urogynecol J. 2021;32(6):1427-1432. https://doi.org/10.1007/s00192-020-04376-4

19. Sun MJ, Cheng YS, Sun R, et al. Changes in mitochondrial DNA copy number and extracellular matrix (ECM) proteins in the uterosacral ligaments of premenopausal women with pelvic organ prolapse. Taiwan J Obstet Gynecol. 2016;55(1):9-15. https://doi.org/10.1016/j.tjog.2014.04.032

20. Kudish BI, Iglesia CB, Sokol RJ, et al. Effect of weight change on natural history of pelvic organ prolapse. Obstet Gynecol. 2009;113(1):81-88. https://doi.org/10.1097/AOG.0b013e318190a0dd

21. Myers DL, Sung VW, Richter HE, et al. Prolapse symptoms in overweight and obese women before and after weight loss. Female Pelvic Med Reconstr Surg. 2012;18(1):55-59. https://doi.org/10.1097/SPV.0b013e31824171f9

22. Oliveira DA, Parente MPL, Calvo B, et al. The management of episiotomy technique and its effect on pelvic floor muscles during a malposition childbirth. Comput Methods Biomech Biomed Engin. 2017;20(11):1249-1259. https://doi.org/10.1080/10255842.2017.1349762

23. Ghersel FR, Souto RP, Gonzales EWP, et al. Assessment of Metalloproteinase Matrix 9 (MMP9) Gene Polymorphisms Risk Factors for Pelvic Organ Prolapse in the Brazilian Population. Rev Bras Ginecol Obstet. 2019;41(3):164-169. https://doi.org/10.1055/s-0039-1681112

24. Kinman CL, Lemieux CA, Agrawal A, et al. The relationship between age and pelvic organ prolapse bother. Int Urogynecol J. 2017;28(5):751-755. https://doi.org/10.1007/s00192-016-3175-5

25. Il'ina I.J., Dobrohotova Ju.Je., Jumina S.V. Gormonal'nyj status u zhenshhin reproduktivnogo vozrasta s displaziej soedinitel'noj tkani i bez nee. Vestnik Rossijskogo universiteta druzhby narodov. Serija: medicina. 2010;(2):65-69. (In Russ.).

26. Hanzadjan M.L., Demura T.A. Osobennosti soedinitel'noj tkani svjazochnogo apparata matki u zhenshhin s prolapsom genitalij. Kazanskij medicinskij zhurnal. 2015;96(4):498-505. (In Russ.). https://doi.org/10.17750/KMJ2015-498

27. Yashchuk А.G., Musin I.I., Fatkullina I.B., et al. Clinical and genetic parallels between connective tissue disease, genital prolapse and joint hypermobility syndrome. Vopr. ginekol. akus. perinatol. (Gynecology, Obstetrics and Perinatology). 2018;17(4):31-35. (In Russ.).https://doi.org/10.20953/1726-1678-2018-4-31-35

28. Li Z, Xu T, Li Z, et al. An epidemiologic study of pelvic organ prolapse in postmenopausal women: a population-based sample in China. Climacteric. 2019;22(1):79-84. https://doi.org/10.1080/13697137.2018.1520824

29. Hicks CW, Weinstein M, Wakamatsu M, et al. Are rectoceles the cause or the result of obstructed defaecation syndrome? A prospective anorectal physiology study. Colorectal Dis. 2013;15(8):993-999. https://doi.org/10.1111/codi.12213

30. Bharucha AE, Knowles CH. Rectocele: Incidental or important? Observe or operate? Contemporary diagnosis and management in the multidisciplinary era. Neurogastroenterol Motil. 2022;34(11):e14453. https://doi.org/10.1111/nmo.14453

31. Manatakis DK, Gouvas N, Pechlivanides G, et al. Ventral Prosthesis Rectopexy for obstructed defaecation syndrome: a systematic review and meta-analysis. Updates Surg. 2022;74(1):11-21. https://doi.org/10.1007/s13304-021-01177-2

32. Mustain WC. Functional Disorders: Rectocele. Clin Colon Rectal Surg. 2017;30(1):63-75. https://doi.org/10.1055/s-0036-1593425. PMID: 28144214

33. Tan C, Tan M, Geng J, et al. Rectal-vaginal pressure gradient in patients with pelvic organ prolapse and symptomatic rectocele. BMC Womens Health. 2021;21(1):165. https://doi.org/10.1186/s12905-021-01304-6

34. Noé GK, Alkatout I, Schiermeier S, et al. Laparoscopic anterior and posterior native tissue repair: a new pelvic floor approach. Minim Invasive Ther Allied Technol. 2019;28(4):241-246. https://doi.org/ 10.1080/13645706.2018.1510420

35. Yang Y, Cao YL, Zhang YY, et al. Clinical efficacy of integral theory-guided laparoscopic integral pelvic floor/ligament repair in the treatment of internal rectal prolapse in females. World J Clin Cases. 2020;8(23):5876-5886. https://doi.org/10.12998/wjcc.v8.i23.5876

36. Jelovsek JE, Maher C, Barber MD. Pelvic organ prolapse. Lancet. 2007;369(9566):1027-1038. https://doi.org/10.1016/S0140-6736(07)60462-0

37. Ishchenko A.I., Yashchuk A.G., Aleksandrov L.S., et al. Polyetiological pathogenesis of pelvic organ prolapse in women. Current understanding of the problem. Vopr. ginekol. akus. perinatol. (Gynecology, Obstetrics and Perinatology). 2022;21(1):76-84. (In Russ.). https://doi.org/10.20953/1726-1678-2022-1-76-84

38. Rortveit G, Brown JS, Thom DH, et al. Symptomatic pelvic organ prolapse: prevalence and risk factors in a population-based, racially diverse cohort. Obstet Gynecol. 2007;109(6):1396-1403. https://doi.org/10.1097/01.AOG.0000263469.68106.90

39. Kufaishi H, Alarab M, Drutz H, et al. Static Mechanical Loading Influences the Expression of Extracellular Matrix and Cell Adhesion Proteins in Vaginal Cells Derived from Premenopausal Women with Severe Pelvic Organ Prolapse. Reproductive Sciences. 2016;23(8):978-992. https://doi.org/10.1177/1933719115625844

40. Rashidi F, Mirghafourvand M. Pelvic floor disorder and relevant factors in Iranian women of reproductive age: a cross-sectional study. BMC Womens Health. 2023;23(1):71. https://doi.org/10.1186/s12905-023-02226-1

41. de Oliveira MS, Cavalcanti Gde A, da Costa AA. Native vaginal tissue repair for genital prolapse surgical treatment: a minimum of 30 months of results. Eur J Obstet Gynecol Reprod Biol. 2016;201:75-78. https://doi.org/10.1016/j.ejogrb.2016.03.020

42. Persu C, Chapple CR, Cauni V, et al. Pelvic Organ Prolapse Quantification System (POP-Q) – a new era in pelvic prolapse staging. J Med Life. 2011;4(1):75-81. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3056425

43. Ellerkmann RM, Cundiff GW, Melick CF, et al. Correlation of symptoms with location and severity of pelvic organ prolapse. Am J Obstet Gynecol. 2001;185(6):1332-1337; discussion 1337-1338. https://doi.org/10.1067/mob.2001.119078

44. Cameron AP, Smith AR, Lai HH, et al. Bowel function, sexual function, and symptoms of pelvic organ prolapse in women with and without urinary incontinence. Neurourol Urodyn. 2018;37(8):2586-2596. https://doi.org/10.1002/nau.23587

45. Iglesia CB, Smithling KR. Pelvic Organ Prolapse. Am Fam Physician. 2017;96(3):179-185. https://www.aafp.org/pubs/afp/issues/2017/0801/p179.html

46. Barber MD, Walters MD, Cundiff GW. Responsiveness of the Pelvic Floor Distress Inventory (PFDI) and Pelvic Floor Impact Questionnaire (PFIQ) in women undergoing vaginal surgery and pessary treatment for pelvic organ prolapse. Am J Obstet Gynecol. 2006;194(5):1492-1498. https://doi.org/10.1016/j.ajog.2006.01.076

47. Rortveit G, Daltveit AK, Hannestad YS, et al. Urinary incontinence after vaginal delivery or cesarean section. N Engl J Med. 2003;348(10):900-907. https://doi.org/110.1056/NEJMoa021788

48. Carlin GL, Morgenbesser R, Kimberger O, et al. Does the choice of pelvic organ prolapse treatment influence subjective pelvic-floor related quality of life? Eur J Obstet Gynecol Reprod Biol. 2021;259:161-166. https://doi.org/10.1016/j.ejogrb.2021.02.018

49. Insights Into Incontinence and the Pelvic Floor. Editors: Fulya Dökmeci, Diaa EE. Rizk: 2022. https://doi.org/10.1007/978-3-030-94174-1

50. Rogers RG, Coates KW, Kammerer-Doak D, et al. A short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). Int Urogynecol J Pelvic Floor Dysfunct. 2003;14(3):164-168; discussion 168. https://doi.org/10.1007/s00192-003-1063-2

51. Wu JM, Matthews CA, Conover MM, et al. Lifetime risk of stress urinary incontinence or pelvic organ prolapse surgery. Obstet Gynecol. 2014;123(6):1201-1206. https://doi.org/10.1097/AOG.0000000000000286

52. Dubinskaya E.D., Babicheva I.A., Kolesnikova S.N., et al. Sexual function in patients with early forms of pelvic organ prolapse. RUDN Journal of Medicine. 2016;(2):76-81. (In Russ.).

53. Morciano A, Schiavi MC, Frigerio M, et al. Quality of Life and Sexual Function after Laparoscopic Posterior Vaginal Plication Plus Sacral Colpopexy for Severe Posterior Vaginal Prolapse. J Clin Med. 2024;13(2):616. https://doi.org/10.3390/jcm13020616

54. Weber AM, Walters MD, Piedmonte MR. Sexual function and vaginal anatomy in women before and after surgery for pelvic organ prolapse and urinary incontinence. Am J Obstet Gynecol. 2000;182(6):1610-1615. https://doi.org/10.1067/mob.2000.107436

55. Tso C, Lee W, Austin-Ketch T, et al. Nonsurgical Treatment Options for Women With Pelvic Organ Prolapse. Nursing for Women’s Health 2018; 22(3):228-239. https://doi.org/10.1016/J.NWH.2018.03.007

56. Van den Broeck S, Nullens S, Jacquemyn Y, et al. Posterior compartment prolapse and perineal descent: systematic review of available support devices. Int Urogynecol J. 2023;34(11):2629-2645. https://doi.org/10.1007/s00192-023-05508-2

57. Powers SA, Burleson LK, Hannan JL. Managing female pelvic floor disorders: a medical device review and appraisal. Interface Focus. 2019;9(4):20190014. https://doi.org/10.1098/rsfs.2019.0014

58. Hall GM, Shanmugan S, Nobel T, et al. Symptomatic rectocele: what are the indications for repair? Am J Surg 2014;207(3):375-379; discussion 378-379. https://doi.org/10.1016/j.amjsurg.2013.12.002

59. Barbalat Y, Tunuguntla HS. Surgery for pelvic organ prolapse: a historical perspective. Curr Urol Rep. 2012;13(3):256-261. https://doi.org/10.1007/s11934-012-0249-x

60. Naumov A.V., Kulikovskij V.F., Olejnik N.V. Ocenka rezul'tatov hirurgicheskogo lechenija rektocele na fone kombinirovannoj patologii tazovogo dna i v zavisimosti ot operativnogo dostupa. Vestnik jeksperimental'noj i klinicheskoj hirurgii. 2009; 2(2):129-136. (In Russ.).

61. Mowat A, Maher D, Baessler K, et al. Surgery for women with posterior compartment prolapse. Cochrane Database Syst Rev. 20185;3(3):CD012975. https://doi.org/10.1002/14651858.CD012975

62. Doumouchtsis SK, Raheem AA, Milhem Haddad J, et al. An update of a former FIGO Working Group Report on Management of Posterior Compartment Prolapse. Int J Gynaecol Obstet. 2020;148(2):135-144. https://doi.org/10.1002/ijgo.13006

63. Tasev V, Todorov R, Taseva A. Rectocele - a literature review with a case report. Khirurgiia (Sofiia). 2015;81(1):34-7. https://europepmc.org/article/med/26506638

64. Ferrari L, Cuinas K, Hainsworth A, et al. Transvaginal rectocoele repair for the surgical treatment of a "symptomatic" rectocoele when conservative measures fail: A 12 year experience of 215 patients. Neurogastroenterol Motil. 2022;34(11):e14343. https://doi.org/10.1111/nmo.14343

65. Ilkanich A.Y., Matveeva A.S., Lopatskaya Z.N. Assessment of quality of life in patients with pelvic organ prolapse after prosthetic reconstruction via vaginal access. Vestnik NovSU. Issue: Medical Sciences. 2021;3(124):99-102. (In Russ.). https://doi.org/10.34680/2076-8052.2021.3(124).99-102

66. Hаylen BT, Wong A, Kerr S. Posterior vaginal compartment repairs: Does vaginal vault (level I) fixation significantly improve the vaginal introital (level III) repair? Neurourol Urodyn. 2018;37(8):2740-2744. https://doi.org/10.1002/nau.23737

67. Claerhout F, De Ridder D, Roovers JP, et al. Medium-term anatomic and functional results of laparoscopic sacrocolpopexy beyond the learning curve. Eur Urol. 2009;55(6):1459-1467. https://doi.org/10.1016/j.eururo.2008.12.008

68. Fox SD, Stanton SL. Vault prolapse and rectocele: assessment of repair using sacrocolpopexy with mesh interposition. BJOG. 2000;107(11): 1371-1375. https://doi.org/10.1111/j.1471-0528.2000.tb11650.x

69. Bellido Luque J, Limón Padilla J, García Moreno J, et al. Three years prospective clinical and radiologic follow-up of laparoscopic sacrocolpoperineopexy. Surg Endosc. 2021;35(11):5980-5990. https://doi.org/10.1007/s00464-020-08083-5

70. Kwak HD, Ju JK. Laparoscopic Rectovaginal Septal Repair without Mesh for Anterior Rectocele. J Minim Invasive Surg. 2018;21:177-179. https://doi.org/10.7602/jmis.2018.21.4.177

71. Popov A.A., Krasnopol'skaja I.V., Fedorov A.A., et al. Sovremennye setchatye implanty v hirurgii genital'nogo prolapsa. Akusherstvo i ginekologija Sankt-Peterburga. 2018;3-4:57-58. (In Russ.).

72. Dällenbach P. To mesh or not to mesh: a review of pelvic organ reconstructive surgery. Int J Womens Health. 2015;7:331-343. https://doi.org/10.2147/IJWH.S71236

73. Ishchenko A.I., Aleksandrov L.S., Ishchenko A.A., et al. Mesh-ligature correction of posterior vaginal wall prolapse grade II–III using titanium mesh implants. Vopr. ginekol. akus. perinatol. (Gynecology, Obstetrics and Perinatology). 2020;19(3):14-21. (In Russ.). https://doi.org/10.20953/1726-1678-2020-3-14-21

74. Paraiso MF, Barber MD, Muir TW, et al. Rectocele repair: a randomized trial of three surgical techniques including graft augmentation. Am J Obstet Gynecol. 2006;195(6):1762-1771. https://doi.org/10.1016/j.ajog.2006.07.026

75. Withagen MI, Milani AL, den Boon J, et al. Trocar-guided mesh compared with conventional vaginal repair in recurrent prolapse: a randomized controlled trial. Obstet Gynecol. 2011;117(2 Pt 1):242-250. https://doi.org/10.1097/AOG.0b013e318203e6a5

76. Karram M, Maher C. Surgery for posterior vaginal wall prolapse. Int Urogynecol J. 2013;24(11):1835-1841. https://doi.org/10.1007/s00192-013-2174-z

77. Kontogiannis S, Goulimi E, Giannitsas K. Reasons for and Against Use of Non-absorbable, Synthetic Mesh During Pelvic Organ Prolapse Repair, According to the Prolapsed Compartment. Adv Ther. 2017;33(12):2139-2149. https://doi.org/10.1007/s12325-016-0425-3

78. Schimpf MO, Abed H, Sanses T, et al. Graft and Mesh Use in Transvaginal Prolapse Repair: A Systematic Review. Obstet Gynecol. 2016;128(1):81-91. https://doi.org/10.1097/AOG.0000000000001451

79. Grimes CL, Schimpf MO, Wieslander CK, et al. Surgical interventions for posterior compartment prolapse and obstructed defecation symptoms: a systematic review with clinical practice recommendations. Int Urogynecol J. 2019;30(9):1433-1454. https://doi.org/10.1007/s00192-019-04001-z

80. Davis K, Kumar D. Posterior pelvic floor compartment disorders. Best Pract Res Clin Obstet Gynaecol. 2005;19(6):941-958. https://doi.org/10.1016/j.bpobgyn.2005.08.010

81. Henn EW, Cronje HS. Rectocele plication: description of a novel surgical technique and review of clinical results. Int Urogynecol J. 2018;29(11):1655-1660. https://doi.org/10.1007/s00192-018-3623-5

82. Marino G, Frigerio M, Barba M, et al. Native Tissue Posterior Compartment Repair for Isolated Posterior Vaginal Prolapse: Anatomical and Functional Outcomes. Medicina (Kaunas). 2022;58(9):1152. https://doi.org/10.3390/medicina58091152

83. Cundiff GW, Weidner AC, Visco AG, et al. An anatomic and functional assessment of the discrete defect rectocele repair. Am J Obstet Gynecol. 1998;179(6 Pt 1):1451-1456; discussion 1456-1457. https://doi.org/10.1016/s0002-9378(98)70009-2

84. Glavind K, Christiansen AG. Site-specific colporrhaphy in posterior compartment pelvic organ prolapse. Int Urogynecol J. 2016;27(5):735-9. https://doi.org/10.1007/s00192-015-2870-y

85. Berkowitz LR, Hudson PL. Site-specific posterior colporrhaphy and perineorrhaphy for rectocele. J Med Insight. 2022;2022(269). https://doi.org/10.24296/jomi/269

86. Gluck O, Matani D, Rosen A, et al. Surgical Treatment for Rectocele by Posterior Colporrhaphy Compared to Stapled Transanal Rectal Resection. J Clin Med. 2023;12(2):678. https://doi.org/10.3390/jcm12020678

87. Maher CF, Qatawneh AM, Baessler K, et al. Midline rectovaginal fascial plication for repair of rectocele and obstructed defecation. Obstet Gynecol. 2004;104(4):685-689. https://doi.org/10.1097/01.AOG.0000139833.48063.03

88. Bedel A, AgostinI A, Netter A, et al. Midline rectovaginal fascial plication: Anatomical and functional outcomes at one year. J Gynecol Obstet Hum Reprod. 2022;51(4):102327. https://doi.org/10.1016/j.jogoh.2022.102327

89. Kahn MA, Stanton SL. Posterior colporrhaphy: its effects on bowel and sexual function. Br J Obstet Gynaecol. 1997;104(1):82-86. https://doi.org/10.1111/j.1471-0528.1997.tb10654.x

90. Balata M, Elgendy H, Emile SH, et al. Functional Outcome and Sexual-Related Quality of Life After Transperineal Versus Transvaginal Repair of Anterior Rectocele: A Randomized Clinical Trial. Dis Colon Rectum. 2020;63(4):527-537. https://doi.org/10.1097/DCR.0000000000001595

91. Abdelnaby M, Fathy M, Abdallah E, et al. Laparoscopic Ventral Mesh Rectopexy Versus Transvaginal Posterior Colporrhaphy in Management of Anterior Rectocele. J Gastrointest Surg. 2021;25(8):2035-2046. https://doi.org/10.1007/s11605-020-04823-z

92. Regadas FSP, Murad-Regadas SM, Rodrigues LV, et al. Impact of TRREMS on symptoms of obstructed defecation due to rectocele: predictive factors and outcomes. Tech Coloproctol. 2020;24(1):65-73. https://doi.org/10.1007/s10151-019-02131-6

93. Leal VM, Regadas FS, Regadas SM, et al. Clinical and functional evaluation of patients with rectocele and mucosal prolapse treated with transanal repair of rectocele and rectal mucosectomy with a single circular stapler (TRREMS). Tech Coloproctol. 2010;14(4):329-335. https://doi.org/10.1007/s10151-010-0649-1

94. Mahmoud SA, Omar W, Farid M. Transanal repair for treatment of rectocele in obstructed defaecation: manual or stapled. Colorectal Dis. 2012;14(1):104-110. https://doi.org/10.1111/j.1463-1318.2010.02502.x

95. Khubchandani IT, Clancy JP 3rd, Rosen L, et al. Endorectal repair of rectocele revisited. Br J Surg. 1997;84(1):89-91. https://doi.org/10.1046/j.1365-2168.1997.02463.x

96. Farid M, Madbouly KM, Hussein A, et al. Randomized controlled trial between perineal and anal repairs of rectocele in obstructed defecation. World J Surg. 2010;34(4):822-829. https://doi.org/10.1007/s00268-010-0390-y

97. Gentile M, De Rosa M, Cestaro G, et al. Internal Delorme vs. STARR procedure for correction of obstructed defecation from rectocele and rectal intussusception. Ann Ital Chir. 2014;85(2):177-183.

98. Ren XH, Yaseen SM, Cao YL, et al. A transanal procedure using TST STARR Plus for the treatment of Obstructed Defecation Syndrome: 'A mid-term study'. Int J Surg. 2016;32:58-64. https://doi.org/10.1016/j.ijsu.2016.06.039

99. Naldini G, Fabiani B, Menconi C, et al. Treatment of obstructed defecation syndrome due to rectocele and rectal intussusception with a high volume stapler (TST STARR-plus). Tech Coloproctol. 2018;22(1):53-58. https://doi.org/10.1007/s10151-017-1696-7

100. Boccasanta P, Venturi M, Roviaro G. What is the benefit of a new stapler device in the surgical treatment of obstructed defecation? Three-year outcomes from a randomized controlled trial. Dis Colon Rectum. 2011;54(1):77-84. https://doi.org/10.1007/DCR.0b013e3181e8aa73

101. Zhang B, Ding JH, Zhao YJ, et al. Midterm outcome of stapled transanal rectal resection for obstructed defecation syndrome: a single-institution experience in China. World J Gastroenterol. 2013;19(38):6472-6478. https://doi.org/10.3748/wjg.v19.i38.6472

102. Ripamonti L, Guttadauro A, Lo Bianco G, et al. Stapled Transanal Rectal Resection (Starr) in the Treatment of Obstructed Defecation: A Systematic Review. Front Surg. 2022;9:790287. https://doi.org/10.3389/fsurg.2022.790287

103. Meng J, Yin ZT, Zhang YY, et al. Therapeutic effects of the TST36 stapler on rectocele combined with internal rectal prolapse. World J Gastrointest Surg. 2021;13(5):443-451. https://doi.org/10.4240/wjgs.v13.i5.443

104. Lisi G, Campanelli M, Grande S, et al. Transperineal rectocele repair with biomesh: updating of a tertiary refer center prospective study. Int J Colorectal Dis. 2018;33(11):1583-1588. https://doi.org/10.1007/s00384-018-3054-2

105. Fathy M, Elfallal AH, Emile SH. Literature review of the outcome of and methods used to improve transperineal repair of rectocele. World J Gastrointest Surg. 2021;13(9):1063-1078. https://doi.org/10.4240/wjgs.v13.i9.1063

106. Omar W, Elfallal AH, Emile SH, et al. Horizontal versus vertical plication of the rectovaginal septum in transperineal repair of anterior rectocele: a pilot randomized clinical trial. Colorectal Dis. 2021;23(4):923-931. https://doi.org/10.1111/codi.15483

107. Zimmermann EF, Hayes RS, Daniels IR, et al. Transperineal rectocele repair: a systematic review. ANZ J Surg. 2017;87(10):773-779. https://doi.org/10.1111/ans.14068

108. Youssef M, Emile SH, Thabet W, et al. Comparative Study Between Trans-perineal Repair With or Without Limited Internal Sphincterotomy in the Treatment of Type I Anterior Rectocele: a Randomized Controlled Trial. J Gastrointest Surg. 2017;21(2):380-388. https://doi.org/10.1007/s11605-016-3299-4

109. Musaev Kh.N. Surgical treatment of rectocele. Khirurgiia (Mosk). 2009;8:38-40. (In Russ.).

110. Oleinik NV, Krivchikova AP, Yarosh AL, et al. Prevention of dyspareunia when performing transvaginal rectocele correction. International Research Journal. 2023;1(127):73. https://doi.org/10.23670/IRJ.2023.127.155

111. Lamah M, Ho J, Leicester RJ. Results of anterior levatorplasty for rectocele. Colorectal Dis. 2001;3(6):412-416. https://doi.org/10.1046/j.1463-1318.2001.00245.x

112. Maeda K, Honda K, Koide Y, et al. Outcomes of Transvaginal Anterior Levatorplasty with Posterior Colporrhaphy for Symptomatic Rectocele. J Anus Rectum Colon. 2021;5(2):137-143. https://doi.org/10.23922/jarc.2020-062

113. Shao Y, Fu YX, Wang QF, et al. Khubchandani's procedure combined with stapled posterior rectal wall resection for rectocele. World J Gastroenterol. 2019;25(11):1421-1431. https://doi.org/10.3748/wjg.v25.i11.1421

114. Kim JH, Kim DH, Lee YP. Long-term comparison of physiologic anorectal changes and recurrence between transanal repair and transanal repair with posterior colporrhaphy in rectocele. Asian J Surg. 2020;43(1):265-271. https://doi.org/10.1016/j.asjsur.2019.04.001

115. Shafik AA, El Sibai O, Shafik IA. Rectocele repair with stapled transvaginal rectal resection. Tech Coloproctol. 2016;20(4):207-214. https://doi.org/10.1007/s10151-015-1410-6

116. Sung VW, Rardin CR, Raker CA, et al. Porcine subintestinal submucosal graft augmentation for rectocele repair: a randomized controlled trial. Obstet Gynecol. 2012;119(1):125-133. https://doi.org/10.1097/AOG.0b013e31823d407e

117. Shelygin Yu.A., Biryukov O.M., Titov A.Yu., et al. Application of synthetic and biological implants for fixation of rectovaginal septum in rectocele repair. Grekov's Bulletin of Surgery. 2017;176(4):51-54. (In Russ.). https://doi.org/10.24884/0042-4625-2017-176-4-51-54

118. Abramov Y, Gandhi S, Goldberg RP, et al. Site-specific rectocele repair compared with standard posterior colporrhaphy. Obstet Gynecol. 2005;105(2):314-318. https://doi.org/10.1097/01.AOG.0000151990.08019.30

119. Nieminen K, Hiltunen KM, Laitinen J, et al. Transanal or vaginal approach to rectocele repair: a prospective, randomized pilot study. Dis Colon Rectum. 2004;47(10):1636-1642. https://doi.org/10.1007/s10350-004-0656-2

120. Nüssler E, Granåsen G, Nüssler EK, et al. Repair of recurrent rectocele with posterior colporrhaphy or non-absorbable polypropylene mesh-patient-reported outcomes at 1-year follow-up. Int Urogynecol J. 2019;30(10):1679-1687. https://doi.org/10.1007/s00192-018-03856-y

121. Dariane C, Moszkowicz D, Peschaud F. Concepts of the rectovaginal septum: implications for function and surgery. International Urogynecology Journal. 2016;27(6):839-848. https://doi.org/10.1007/S00192-015-2878-3

122. Solov'ev I.A., Luk'janjuk P.P., Surov D.A., et al. Fascii slijanija i ih rol' v hirurgii mestnorasprostranennyh opuholej tolstoj kishki. Medline.ru. Rossijskij biomedicinskij zhurnal. 2020;21:1038-1049. (In Russ.).

123. Maher CF, Baessler KK, Barber MD, et al. Summary: 2017 International Consultation on Incontinence Evidence-Based Surgical Pathway for Pelvic Organ Prolapse. Female Pelvic Med Reconstr Surg. 2020;26(1):30-36. https://doi.org/10.1097/SPV.0000000000000591