Pelvic organ prolapse suspension and stapled transanal rectal resection in treatment of obstructing defecation

In the normal individual the anorectal angle is a factor in maintaining faecal continence. If intra-abdominal pressure is transmitted to the anterior rectal wall, for example during coughing or sneezing, mucosa will be forced onto the upper part of the anal canal to form a flap-valve. In patients with the descending perineum syndrome, the anorectal angle is disrupted because it lies at a lower level than normal and the patient is complaining of feeling of incomplete evacuation and straining that lead to rectorectal intussusception and/ or rectocele Correction of rectorectal intussusception and/ or rectocele can be done by stapled transanal rectal resection or abdominally by pelvic organ suspension using ventral rectopexy. Pelvic organ prolapsed suspension using ventral rectopexy and stapled transanal rectal resection can solve the anatomical problem of obstructed defecation, however no data which would have better results in multiparous females . Purpose of the study is to compare the outcome of laparoscopic ventral rectopexy versus stapled transanal rectal resection in obstructed defecation in elderly. Our hypothesis is that Laparoscopic ventral rectopexy will have better results as in these patients there is usually weakness of pelvic floor which is not supported in case of stapled transanal rectal resection Patients and Methods: 80 patients with descending perineal syndrome and obstructed defecation above 70 years of age will be treated by laparoscopic ventral mesh rectopexy or stapled transanal rectal resection by random choice ( two equal groups)