[Surgical rectocele repair - many techniques, few unambiguous conclusions]

Surgical treatment of rectocele represents a controversial issue on the boundary between medical specialisations with many different corrective surgical techniques. Is it possible, based on the available knowledge, to determine an optimal operative technique for rectocele repair?

Complex literature search focusing on the identification of rectocele surgical repair studies in the MEDLINE, PubMed and Google Scholar databases. The aim of this paper is to offer a comprehensive review of the contemporary situation as regards rectocele surgical repair.

There are four main possible approaches for rectocele repair - transvaginal, transanal, transperineal and transabdominal. Posterior colporrhaphy with levatoroplasty is the traditional transvaginal technique, performed at most gynaecological departments in various modifications. Defect-specific rectocele repair and mesh repair represent newer transvaginal techniques which offer better postoperative functional results, although with the risk of possible serious complications. Traditional transanal rectocele repair (vertical and horizontal plication of the rectovaginal septum) is currently performed only rarely due to its worse results in comparison with the transvaginal approach. Rectal resection using endostaplers (STARR and TRANSTAR techniques) is a modern transanal technique. Stapled rectocele repair leads to the correction of anorectal anatomical conditions and to the improvement of obstructive defecation symptoms with acceptable morbidity. Transperineal approach is usually used in patients with rectocele and anal incontinence due to a proven sphincter defect. Transabdominal laparoscopic approach is based on vaginorectopexy by means of mesh implantation, and it is indicated especially in patients with rectocele and enterocele.

Based on the results of published studies, it is not possible to determine clear guidelines for rectocele surgical repair. Posterior colporrhaphy and stapled transanal repair are the most common techniques in practice. Prospective randomized studies focusing on the comparison between transvaginal and stapled transanal approach for rectocele repair are needed.