Transperineal rectocele repair: a systematic review

• Published in: ANZ journal of surgery Vol. 87; no. 10; pp. 773 - 779
• Main Authors: Zimmermann, Eleanor F., Hayes, Richard S., Daniels, Ian R., Smart, Neil J., Warwick, Andrea M.
• Format: Journal Article
• Language: English
• Published: Melbourne John Wiley & Sons Australia, Ltd 01.10.2017; Blackwell Publishing Ltd
• Subjects: Adult; Aged; Aged, 80 and over; Augmentation; Complications; Female; Humans; Incidence; Maintenance; Male; Middle Aged; pelvic organ prolapse; Perineum - pathology; Perineum - surgery; Postoperative Complications - etiology; Prospective Studies; Quality of Life; Recovery of Function; rectocele; Rectocele - diagnosis; Rectocele - epidemiology; Rectocele - psychology; Rectocele - surgery; Rectum - pathology; Rectum - surgery; Retrospective Studies; Surgery; Surgical Mesh - adverse effects; Systematic review; transperineal; transperineal rectocele; Treatment Outcome; rectocele; transperineal rectocele; pelvic organ prolapse; transperineal
• ISSN: 1445-1433; 1445-2197
• DOI: 10.1111/ans.14068

Background Transperineal rectocele repairs, either as isolated fascial repair or in combination with mesh augmentation, are hypothesized to reduce the risk of complications compared with alternative techniques. Aim The aim of this study was to ascertain long‐term success and complication rates following transperineal rectocele repairs. Method A literature search of PubMed and Embase was performed using the terms ‘transperineal rectocele’, ‘rectocele’, ‘transperineal’ and ‘repair’. Prospective studies, case series and retrospective case note analyses from 1 January 1994 to 1 December 2016 were included. Those that detailed outcomes of the transperineal approach or compared it to transanal/transvaginal approaches were included. The main outcome measures were reported complications and functional outcome scores. Results A total of 14 studies were included. Of 566 patients, 333 (58.8%) underwent a transperineal rectocele repair and 220 (41.2%) a transanal repair. Complications were identified in 27 (12.3%) of the 220 transanal repairs and in 41 (12.3%) of the 333 transperineal repairs. A significant complication following transperineal repair was noted in eight studies. There are not enough data to make a reliable comparison between mesh and non‐mesh transperineal repairs or to compare biological and synthetic mesh use. Limitations Outcome reporting differed between studies, precluding a full meta‐analysis. Conclusion Transperineal rectocele repair offers an effective method of symptom improvement and appears to have a similar complication rate as transanal rectocele repair. Concomitant use of synthetic and biological mesh augmentation is becoming more common; however, high‐quality comparative data are lacking, so a direct comparison between surgical approaches is not yet possible.