الفهرس 
AcknowledgmentOnly 14 pages are availabe for public view
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Abstract
A rectocele is a herniation of the anterior wall of the rectum through the rectovaginal fascia and the posterior vaginal wall that forms a protrusion in the lumen of the vagina. The rectocele leads to symptoms that usually affect females after menopause and result in symptoms of difficult defecation.The cause of the rectocele is controversial but usually involves damage to the soft tissue of the pelvis as a result of vaginal delivery. Childbirth is a common cause that leads to weakness of the tissue supporting the pelvis . There are many methods for repair of rectocele . one of them is transperineal repair. The present randomized study aimed to evaluate the outcome of transperineal repair with vertical folding of the rectovaginal septum compared to horizontal plication in rectocele repair in terms of rates of improvement in patients, degree of improvement of constipation, regurgitation of the anal sinus, postoperative complications, and sex-related quality of life.The study was conducted on 40 patients with rectocele , after a comprehensive clinical and physiological evaluation. The patients was divided into two equal groups randomly one for horizontal plication and the other is for vertical plication .A significant decrease in the Wexner constipation score was recorded in both groups twelve months after surgery. There was no significant difference between the two groups regarding postoperative Wexner score . Rectocele volume showed a significant postoperative decrease in both groups . There was significant improvement in dyspareunia after transverse plication (p = 0.001) but not after the longitudinal folding group (p = 0.1).Vertical and horizontal plication of the rectovaginal septum in TPR conferred comparable improvement in constipation . The horizontal plication technique was followed by a greater reduction in the rectocele size and higher improvement in dyspareunia as compared to the vertical plication technique. Both groups had similar operation time and hospital stay.