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Laparoscopic Ventral Mesh Rectopexy Versus Transvaginal Posterior Colporrhaphy in Management of Anterior Rectocele

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Management of rectocele is challenging. Treatment usually starts with conservative measures and may involve surgical intervention in non-responding patients. We compared the outcomes of transvaginal posterior colporrhaphy (PC) and laparoscopic ventral mesh rectopexy (LVMR) in treatment of anterior rectocele.

Methods

Patients with anterior rectocele who underwent PC or LVMR were functionally assessed using Cleveland Clinic Constipation Score (CCCS) and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). Pelvic Organ Prolapse Quantification System (POP-Q) was used for clinical assessment, defecography for anatomic assessment, and manometry for physiologic assessment. In addition, quality of life was assessed.

Results

A total of 231 female patients with a mean age of 39 years were included to the study. One hundred fifty-nine underwent PC and 72 underwent LVMR. The LVMR group showed significantly a better functional outcome as compared with the PC group (p < 0.0001). The mean of CCCS at 1 year after LVMR was 6 ± 2.3 vs 9.2 ± 1.2 after PC. The mean of PISQ-12 at 1 year after LVMR was 39.3 ± 2.8 vs 35.8 ± 2.2 after PC. LVMR showed better anatomic correction by defecography, had significantly higher quality of life scores, and had a longer operative time as compared with PC, yet with comparable incidence of complications.

Conclusion

PC and LVMR are both effective treatment options for treatment of rectocele. LVMR was associated with better anatomic correction and greater improvement in constipation, sexual symptoms, and quality of life compared with PC. Although LVMR had a longer operation time than PC, the complication rate of the two procedures was comparable.

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Author notes

  1. Mahmoud Abdelnaby and Mohammad Fathy contributed equally to the study and both are qualified as first co-author.

Authors and Affiliations

  1. General Surgery Department, Mansoura University Hospitals, Mansoura University, 60 El-Gomhouria Street, Mansoura, Dakahlia, 35516, Egypt

    Mahmoud Abdelnaby, Mohammad Fathy, Emad Abdallah, Mohamed Balata, Mohamed Arnous & Sameh Hany Emile

  2. General Surgery Department, Qasr Al-Ainy Hospitals, Cairo University, Giza, Egypt

    Hany Maurice Mikhail

Authors
  1. Mahmoud Abdelnaby
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  2. Mohammad Fathy
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  3. Emad Abdallah
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  4. Mohamed Balata
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  7. Sameh Hany Emile
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Contributions

Mahmoud Abdelnaby and Mohammad Fathy designed the study, performed the surgical procedures, and followed the patients. Sameh Emile, Mohammad Fathy, and Hany Mikhail shared in data analysis and writing of the manuscript. Mohamed Balata, Mohamed Arnous and Emad Abdallah contributed to interpretation of data and revised the manuscript. Mahmoud Abdelnaby critically revised the manuscript.

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Correspondence to Sameh Hany Emile.

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The abstract of this manuscript has been accepted as a poster presentation in the virtual ESCP's 15th Scientific and Annual Conference, Vilnius 2020.

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Abdelnaby, M., Fathy, M., Abdallah, E. et al. Laparoscopic Ventral Mesh Rectopexy Versus Transvaginal Posterior Colporrhaphy in Management of Anterior Rectocele. J Gastrointest Surg 25, 2035–2046 (2021). https://doi.org/10.1007/s11605-020-04823-z

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