Literature review of the outcome of and methods used to improve transperineal repair of rectocele

Table 2 Results of modification of classic transperineal repair

Ref.	Methodology	Technique	n	Age	Follow-up	Diagnosis and Assessment	Outcome	Complications
Ellis[32], 2010 (United States)	Retrospective cohort	TPI [porcine intestinal submucosal collagen implant (Surgisis®)] ± SP	32 (entire cohort n = 120)	58.7 ± 8.9	12 mo	BBUSQ-22	Improvement of BBUSQ-22 individual items (total improvement 30.9%): Significant improvement (decline) in 6 items	Urine retention (n = 2), Recurrence (n = 0)
							Significant deterioration (raise) in pain with bowel movements
							Non-significant changes in 2 items
Smart and Mercer-Jones[33], 2007 (United Kingdom)	Prospective case series	TPI [porcine dermal collagen implant (Permacol®)]> Suction drain (last 8 patients)	10	51, median (33-71)	9 mo, median (5-16)	Watson score	All patients (100%) had improvement in 2 or more symptoms, and 70% in three or more	Hematoma (n = 2)
							Decline of Watson score (Pre = 10.5, PO = 4.5)
Hirst et al[29], 2005 (United Kingdom)	Retrospective cohort	TPR + LP + Implant	7 (entire cohort n = 82)	51, median (25-83)	NP	Clinical assessment	Surgery outcome: cured (n = 5 patient), initial improvement (n = 1 patient), no improvement (n = 1 patient), further surgery (n = 2 patient); Satisfaction: n = 6 patient	Mesh erosion (n = 1); Recurrence (n = 1)
Mercer-Jones et al[34], 2004 (United Kingdom)	Retrospective case series	TPI ± SPProlene mesh (n = 14),Prolene + PGA mesh [Vypro II®] (n = 8)	22	53, median (28-66)	12.5 mo (3.0-47.0)	Watson score	Decline in Watson score (Pre = 11.1, PO = 3.9); Significant (P < 0.05) symptomatic improvement (n = 20 patient)	Wound infection (n = 2), wound infection and dehiscence (n = 1), dyspareunia (n = 1) Recurrence (n = 1)
							Subjective outcome (P < 0.05) in favor of Vypro II® mesh: Moderate to excellent [Prolene (n = 9 patient), Vypro II® (n = 8 patient)]
							Poor [prolene (n = 5 patient), Vypro II® (n = 0 patient)]
Azanjac and Jorovic[35], 1999 (Serbia)	Prospective case series	TPI [prolene mesh (Atrium®)]	6	56 (46-68)	11 mo (7-18)	Symptom assessment; Satisfaction assessment	Successful rectal evacuation without digitation (n = 6 patient); Symptom improvement [markedly (n = 2 patient), completely (n = 4 patient)]	Urine retention (n = 1)
							Satisfaction [very satisfied (n = 5 patient), somewhat (n = 1 patient)]
Watson et al[36], 1996 (United Kingdom)	Prospective case series	TPR + LP + Implant [prolene mesh (Marlex®)]	9	50, median (32-61)	29 mo, median (8-36)	Watson scoreFluoroscopic defecography	Significant decline in PO score (Pre = 11.7, PO = 1.9, P < 0.05); No further need for digital evacuation (n = 8); Significant decline in rectocele depth (Pre = 3.7, PO = 2.4, P < 0.05)	Wound infection (n = 1); Dyspareunia: Resolved (n = 1), abstained (n = 2), acquired (n = 1)
							Significant decline in barium trapping (Pre = 14%, PO = 5%, P < 0.005)

BBUSQ-22: 22-Item Birmingham Bowel and Urinary Symptoms Questionnaire; NP: Not provided; PGA: Polyglycolic acid; PO: Postoperative; Pre: Preoperative; SP: Sphincteroplasty; TPI: Transperineal implant; TPR: Transperineal repair (classic vertical plication); LP: Levatorplasty.