Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Nov 24;23(1):359.
doi: 10.1186/s12893-023-02206-0.

Laparoscopic ventral mesh rectopexy vs. transperineal mesh repair for obstructed defecation syndrome associated with rectocele: comparison of selectively distributed patients

Bengi Balci  1 , Sezai Leventoglu  2 , Igbal Osmanov  1 , Beyza Erkan  3 , Yasemin Irkilata  4 , Bulent Mentes  1
Affiliations

Laparoscopic ventral mesh rectopexy vs. transperineal mesh repair for obstructed defecation syndrome associated with rectocele: comparison of selectively distributed patients

Bengi Balci et al. BMC Surg. .

Abstract

Purpose: Obstructed defecation syndrome represents 50-60% of patients with symptoms of constipation. We aimed to compare the two frequently performed surgical methods, laparoscopic ventral mesh rectopexy and transperineal mesh repair, for this condition in terms of functional and surgical outcomes.

Methods: This study is a retrospective review of 131 female patients who were diagnosed with obstructed defecation syndrome, attributed to rectocele with or without rectal intussusception, enterocele, hysterocele or cystocele, and who underwent either laparoscopic ventral mesh rectopexy or transperineal mesh repair. Patients were evaluated for surgical outcomes based on the operative time, the length of hospital stay, operative complications, using prospectively designed charts. Functional outcome was assessed by using the Initial Measurement of Patient-Reported Pelvic Floor Complaints Tool.

Results: Fifty-one patients diagnosed with complex rectocele underwent laparoscopic ventral mesh rectopexy, and 80 patients diagnosed with simple rectocele underwent transperineal mesh repair. Mean age was found to be 50.35 ± 13.51 years, and mean parity 2.14 ± 1.47. Obstructed defecation symptoms significantly improved in both study groups, as measured by the Colorectal Anal Distress Inventory, Constipation Severity Instrument and Patient Assessment of Constipation-Symptoms scores. Minor postoperative complications including wound dehiscence (n = 3) and wound infection (n = 2) occurred in the transperineal mesh repair group.

Conclusion: Laparoscopic ventral mesh rectopexy and transperineal mesh repair are efficient and comparable techniques in terms of improvement in constipation symptoms related to obstructed defecation syndrome. A selective distribution of patients with or without multicompartmental prolapse to one of the treatment arms might be the preferred strategy.

Keywords: Initial Measurement of Patient-Reported Pelvic Floor Complaints Tool; Laparoscopic ventral mesh rectopexy; Obstructed defecation syndrome; Transperineal mesh repair.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Differences between preoperative and postoperative 12th month median IMPACT scores within each group: CRADI-8 scores are presented in (a), CSI-ODS Subscale scores in (b), CSI total scores in (c), and PAC-SYM total scores in (d). Note that p values reflect the differences in preoperative and postoperative CRADI-8, CSI-ODS and CSI scores within each group and the comparisons of outcomes between study group are presented in Table 2. p value was calculated with Wilcoxon matched-pair signed-rank test
Fig. 2
Fig. 2
Suggested-algorithm for patients with obstructed defecation syndrome attributed to rectocele. Abbreviations: LVMR, laparoscopic ventral mesh rectopexy; TPMR, transperineal mesh repair; STARR, stapled transanal rectal resection; TOT, transobturator tape
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Martelli H, Devroede G, Arhan P, Duguay C. Mechanisms of idiopathic constipation: outlet obstruction. Gastroenterology. 1978;75:623–631. doi: 10.1016/S0016-5085(19)31670-1. - DOI - PubMed
    1. Rao SS, Bharucha AE, Chiarioni G, Felt-Bersma R, Knowles C, Malcolm A, et al. Functional anorectal disorders. Gastroenterology. 2016;150(6):143–1442. doi: 10.1053/j.gastro.2016.02.009. - DOI - PMC - PubMed
    1. Pescatori M, Spyrou M, Pulvirenti d’Urso A. A prospective evaluation of occult disorders in obstructed defecation using the ‘iceberg diagram’. Colorectal Dis. 2007;9:452–456. doi: 10.1111/j.1463-1318.2006.01094.x. - DOI - PubMed
    1. Altomare DF. ODS score and obstructed defecation. Dis Colon Rectum. 2010;53:363. doi: 10.1007/DCR.0b013e3181cbf35b. - DOI - PubMed
    1. Zbar AP, Lienemann A, Fritsch H, Beer-Gabel M, Pescatori M. Rectocele: pathogenesis and surgical management. Int J Colorectal Dis. 2003;18:369–384. doi: 10.1007/s00384-003-0478-z. - DOI - PubMed