Introduction Surgical treatment of symptomatic rectocoele is considered for patients where conservative measures have failed. Surgical approaches can be described as transabdominal (TAb), transvaginal (TV), transanal (TA), and transperineal (TP). Transperineal repairs can be performed as an isolated fascial repair or in combination with synthetic or biologic mesh augmentation and are hypothesised to reduce the risk of complications compared with alternative approaches.
Method A systematic review was performed with the aim of ascertaining long-term success and complication rates of transperineal rectocoele repairs.
Results Fourteen studies, comprising seven case series, six comparative studies and one randomised controlled trial were included in this review. Of 566 patients, 333 underwent a transperineal rectocoele repair and 220 a transanal repair. Complications were identified postoperatively in 27/220 (12.3%) transanal repairs and in 41/333 (12.3%) transperineal repairs. Outcome reporting differed between studies precluding full meta-analysis. A significant effect on symptom resolution following TP rectocoele repair was noted in eight studies, one was non significant but showed improvement, and four showed improvement but did not comment on statistical significance of the effect. There is not enough data to make a reliable comparison between mesh and non-mesh transperineal repairs, or to compare biologic and synthetic mesh use.
Conclusion Transperineal rectocoele repair offers an effective method of symptom improvement that appears to be superior to transanal repairs, and is associated with similar complication rates. Concomitant use of synthetic and biologic mesh to enhance the repair is becoming more common, however, high quality comparative data is lacking and further studies are required.
Disclosure of interest None Declared.