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[Avoiding Clustering and Urge in Transanal Surgery for Deep Distal Rectocele].

Discrimination between functional and morphological influences in obstructive defecation syndrome is challenging. The predictability of surgical success is still in discussion. Final understanding of the rectally induced variability in colonic motility is still missing, so that morphological changes cannot solely serve as indication. Finally the physiology of the enteric nervous system has to be taken into account in choosing an approach. A modified Sullivan procedure was tested in the treatment of distal deep rectocele with respect to short- and long-term results for complications, obstructive symptoms and explicitly with regard to urge and clustering complaints. Between January 2009 and January 2014, 35 women complaining of obstructive symptoms with distal deep rectocele were operated on in a modified Sullivan technique. There were no intraoperative nor early postoperative complications; 4 weeks postoperatively no urge or clustering was discovered. In a long-term questionnaire, more than 80% of the patients were satisfied with the procedure; the mean obstructive defecations score was lowered by 9 points.