Systematic Reviews
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Sep 27, 2021; 13(9): 1063-1078
Published online Sep 27, 2021. doi: 10.4240/wjgs.v13.i9.1063
Literature review of the outcome of and methods used to improve transperineal repair of rectocele
Mohammad Fathy, Ahmed Hossam Elfallal, Sameh Hany Emile
Mohammad Fathy, Ahmed Hossam Elfallal, Sameh Hany Emile, General Surgery, Mansoura University Faculty of Medicine, Mansoura 35516, Egypt
Author contributions: Fathy M and Elfallal AH collected the data and wrote the manuscript; Emile SH designed and revised the manuscript.
Conflict-of-interest statement: No conflict of interest to be disclosed by the authors.
PRISMA 2009 Checklist statement: The authors have read the PRISMA guideline, and the manuscript was prepared and revised according to the PRISMA guideline.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sameh Hany Emile, FACS, MBChB, MD, Associate Professor, Surgeon, General Surgery, Mansoura University Faculty of Medicine, 60 ElGomhouria street, Mansoura 35516, Dakahlia, Egypt. sameh200@hotmail.com
Received: January 25, 2021
Peer-review started: January 25, 2021
First decision: June 17, 2021
Revised: June 18, 2021
Accepted: July 22, 2021
Article in press: July 22, 2021
Published online: September 27, 2021
Processing time: 235 Days and 19.6 Hours
Abstract
BACKGROUND

Rectocele is commonly seen in parous women and sometimes associated with symptoms of obstructed defecation syndrome (ODS).

AIM

To assess the current literature in regard to the outcome of the classical transperineal repair (TPR) of rectocele and its technical modifications.

METHODS

An organized literature search for studies that assessed the outcome of TPR of rectocele was performed. PubMed/Medline and Google Scholar were queried in the period of January 1991 through December 2020. The main outcome measures were improvement in ODS symptoms, improvement in sexual functions and continence, changes in manometric parameters, and quality of life.

RESULTS

After screening of 306 studies, 24 articles were found eligible for inclusion to the review. Nine studies (301 patients) assessed the classical TPR of rectocele. The median rate of postoperative improvement in ODS symptoms was 72.7% (range, 45.8%-83.3%) and reduction in rectocele size ranged from 41.4%-95.0%. Modifications of the classical repair entailed omission of levatorplasty, addition of implant, concomitant lateral internal sphincterotomy, changing the direction of plication of rectovaginal septum, and site-specific repair.

CONCLUSION

The transperineal repair of rectocele is associated with satisfactory, yet variable, improvement in ODS symptoms with parallel increase in quality-of-life score. Several modifications of the classical TPR were described. These modifications include omission of levatorplasty, insertion of implants, performing lateral sphincterotomy, changing the direction of classical plication, and site-specific repair. The indications for these modifications are not yet fully clear and need further prospective studies to help tailor the technique to rectocele patients.

Keywords: Transperineal repair; Rectocele; Review; Modifications; Outcome

Core Tip: An organized literature search for studies that assessed the outcome of transperineal repair of rectocele was performed. Out of 306 studies, 24 were found eligible for inclusion to this review. Nine studies (301 patients) assessed the classical transperineal repair of rectocele. The median rate of postoperative improvement in obstructed defecation syndrome symptoms was 72.7% (range, 45.8%-83.3%), whereas reduction in rectocele size ranged from 41.4%-95.0%. Modifications of the classical repair entailed omission of levatorplasty, addition of implant, concomitant lateral internal sphincterotomy, changing the direction of plication of rectovaginal septum, and site-specific repair.