Laparoscopic or transanal repair of rectocele? Comparison of a reduction in rectocele size

Purpose This study aimed to compare the reduction in rectocele size after laparoscopic ventral rectopexy (LVR) with that after transanal repair (TAR). Methods Forty-six patients with rectocele who underwent LVR and 45 patients with rectocele who received TAR between February 2012 and December 2022 were included. This was a retrospective analysis of prospectively collected data. All patients had clinical evidence of a symptomatic rectocele. Bowel function was evaluated using the constipation scoring system (CSS) and fecal incontinence severity index (FISI). Substantial symptom improvement was defined as at least a 50% reduction in the CSS or FISI scores. Evacuation proctography was performed before surgery and 6 months postoperatively. Results Constipation was substantially improved in 40–70% of the LVR patients and 70–90% of the TAR patients over 5 years. Fecal incontinence was markedly improved in 60–90% of the LVR patients across 5 years and in 75% of the TAR patients at 1 year. Postoperative proctography showed a reduction in rectocele size in the LVR patients (30 [20–59] mm preoperatively vs. 11 [0–44] mm postoperatively, P < 0.0001) and TAR patients (33 [20–55] mm preoperatively vs. 8 [0–27] mm postoperatively, P < 0.0001). The reduction rate of rectocele size in the LVR patients was significantly lower than that in the TAR patients (63 [3–100] % vs. 79 [45–100] %, P = 0.047). Conclusion The reduction in rectocele size was lower in the patients who underwent LVR than in those who received TAR.