Anterior levatorplasty was performed to enforce the rectovaginal septum in 5 cases of rectocele with clinical symptoms. The mean age of the patients was 61 years. Two cases had concomitant fecal incontinence, and three cases had urinary incontinence. Anterior levatorplasty with excision and anastomoses of the vaginal wall was the standard operation. Sphincter plication was added in two cases with fecal incontinence. Clinical symptoms and urinary or fecal incontinence were improved in all cases after surgery. Manometric study did not reveal marked changes as a whole, however, minimal distending volume, maximum tolerate volume and resting pressure decreased after surgery in cases which demonstrated abnormal high levels of these parameters before operation. Improvement in resting pressure and the length of high pressure zone were observed in cases with fecal incontinence. However, study on more cases was considered necessary for confirmation and discusions of these changes. Postoperative defecography showed improvement of rectocele in all cases. Anterior levatorplasty for rectocele was suggested to be a procedure which improved the clinical symptoms and morphological disorders.
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