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

Table 4 Results of modification of classic transperineal repair (with the omission of rectovaginal septum plication ± other additions or substitutions)

Ref.	Methodology	Technique	n	Age	Follow-up	Diagnosis and assessment	Outcome	Complications
Fischer et al[43], 2005 (Germany)	Retrospective cohort	TPLP	10(entire cohort n = 36)	59 (30-79)	36 mo (8-110)	Symptom assessment; Fluoroscopic defecography; ARM	Symptom improvement (cured): n = 9 patientAll patients (n = 7) showed improvement in FI	RVF (n = 1), wound infection (n = 1), dyspareunia (n = 1)
							3 out of 6 patients showed no rectocele with defecography
							Non-significant rise of both MRP and MSP
							Satisfaction with functional outcomes: n = 9 patient
Boccasanta et al[44], 2001 (Italy)	Retrospective cohort	TPLP (addition of prolene mesh in 2 patients)	126(entire cohort n = 317)	52.4 (28.0-80.0)	22.8 – 27.5 mo	Symptom assessment; Fluoroscopic defecography; ARM	Outcome (n = 110 patient) at 12 m: excellent (n = 45 patient), fair (n = 58 patient), poor (n = 7 patient)	Vaginal stenosis (n = 2)
							PO defecography: complete absence (44.1%), residual (55.9%); Non-significant rise of both MRP and MSP
Lamah et al[45], 2001 (United Kingdom)	Retrospective case series	TPLP ± SP> suction drain	44	57.5 (35.0-82.0)	42 mo (6-84)	Symptom assessment; Continence assessment; Sexual function assessment; Satisfaction assessment	Symptom assessment: TPLP (n = 33 patient): improvement of lump sensation (n = 28 patient), improvement of defecation (n = 29 patient); TPLP + SP (n = 11 patient): improvement of one or both (n = 8 patient)	Wound infection (n = 2), deteriorated FI (n = 1), dyspareunia (n = 2)
							Continence (n = 11 patient): at Pre [continent (n = 0), incontinent (n = 11)], at 12 mo [continent (n = 5), incontinent (n = 6)], at 24 mo [continent (n = 3), incontinent (n = 8)], > 36 mo [continent (n = 3), incontinent (n = 8)]
							Sexual function: TPLP [Improved (n = 8), unchanged (n = 9), deteriorated (n = 2), declined (n = 10)]; TPLP + SP [Improved (n = 2), unchanged (n = 2), deteriorated (n = 0), declined (n = 5)]
							Satisfaction (satisfied / total): TPLP [at 2 yr: (n = 30/33), at 3.2 yr (n = 21/24)]; TPLP + SP [at 2 yr (10/11), at 3.2 yr (6/11)]
Van Laarhoven et al[31], 1999 (United Kingdom)	Retrospective cohort	TPI + LP [prolene mesh (Marlex®)]	5 (entire cohort n = 22)	52.1 (31.0-81.0)	27 mo, median (5-54)	Symptom assessmentFluoroscopic defecographyPudendal nerve motor latency	Ability to evacuate rectum: improved (72.7%), unchanged (22.7%), deteriorated (4.5%); Significant decline in feeling of incomplete evacuation (Pre = 86.4%, PO = 45.5%, P = 0.01); Significant decline in rectocele depth (Pre = 2.9 cm, PO = 1.7 cm, P < 0.01); Significant decline in rectocele area (Pre = 7.8 cm, PO = 4.3 cm, P < 0.01); No correlation between rectocele reduction and symptoms improvement	Wound infection (9.1%)
Parker and Phillips[46], 1993 (United Kingdom)	Retrospective case series	TPI + LP [prolene mesh (Marlex®)]	4	42-65	14 mo (6-18)	Symptom assessment	Successful rectal evacuation without digitation (n = 3), digitation occasionally (n = 1); Satisfaction (n = 4)	NP

ARM: Anorectal manometry; FI: Fecal incontinence; LP: Levatorplasty; MRP: Maximum resting pressure; MSP: Maximum squeeze pressure; NP: Not provided; PO: Postoperative; Pre: Preoperative; RVF: Rectovaginal fistula; SP: Sphincteroplasty; TPI: Transperineal implant; TPLP: Transperineal levatorplasty.