The Advantages of Transanal Access in the Correction of Rectocele in Combinationwith Prolapse of the Rectal Mucosa and Hemorrhoids on the Background of Obstructed Defecation Syndrome

Pelvic organ prolapse in the posterior segment of the pelvis, which is manifested by the obstructed defecation syndrome is an unfavorable factor in the development and further course of hemorrhoidal disease. The most common cause of obstructed defecation is rectocele, and the presence of prolapse of the rectal mucosa in this category of patients exacerbates the course of the disease. Combined surgical treatment is required to improve the results of treatment of this pathology. The aim of the study was to select and justify the method of surgical treatment of this combined pathology. The study material and methods: two groups of patients were selected (the main one and the control one, 20 patients each) with rectocele of the 3rd degree, prolapse of the rectal mucosa, which was manifested by obstructed defecation syndrome, and hemorrhoids of the 3-4th degree. The authors propose a transanal rectocele correction approach with excision of the excess rectal mucosa and ligation in the submucosal layer of hemorrhoidal arteries, followed by hemorrhoids pexia and mucosal restoration, which was used in the main study group. The control group of patients underwent rectocele correction by vaginal access and ligation of hemorrhoidal arteries with mucopexy (HAL–RAR). The results were evaluated using clinical methods, ultrasound, MRI and defecography in the immediate postoperative period, after 6 months and after two years. Results. In the immediate postoperative period, there were no significant complications in both groups. After six months, the patients of both groups showed no anatomical abnormalities or recurrence of hemorrhoidal disease. In the long term, the HAL–RAR technique with mucopexia in relation to the correction of prolapse of the rectal mucosa and hemorrhoidal disease is less effective than the transanal correction of pathology.