Functional and sexual outcome of laparoscopic ventral mesh rectopexy vs transperineal mesh repair in the treatment of rectocele: a retrospective analysis

Aim This study aimed to compare functional outcomes and quality of life, between transperineal mesh repair (TPMR) and laparoscopic ventral mesh rectopexy (LVMR) in the treatment of rectocele. Methods Consecutive women with symptomatic rectocele without associated internal rectal prolapse or enterocele who underwent TPMR (n = 15) or LVMR (n = 20) from January 2013 to February 2019 were included. This study was a retrospective review of a prospectively maintained database. Patient demographics and postoperative complications were evaluated. Altomare's obstructed defecation (OD) and Cleveland Clinic Incontinence Scores (CCIS), Patient Assessment of Constipation Quality of Life (PAC-QoL), Short-Form 36 Health Survey (SF-36) and Female Sexual Function Index (FSFI) were compared before, 3 months, and 12 months after surgery. Results The median follow-up was 49 (range 13-65) and 28 (range 13-60) months in the TPMR (mean age 47.8 +/- 11.7, years) and LVMR (mean age of 52.4 +/- 9.9 years) cohort, respectively. Incontinence, OD, and PAC-QoL scores significantly improved at 3 and 12 months after surgery in both groups. FSFI did not deteriorate 3 and 12 months after LVMR. FSFI scores significantly improved 3 months after TPMR, but a significant deterioration was observed 12 months after TPMR. A gradual increase observed for SF-36 3 months after surgery in both groups, and six of the eight subscale scores improved at 12 months, but social functioning in both groups and vitality in the TPMR group returned to baseline scores. Conclusions TPMR and LVMR improved defecation. Sexual function was not worsened after LVMR, and some individual domains of FSFI worsened after TPMR.