Research Article

Transperineal Site-Spesific Fascial Repair vs. Transperineal Polypropylene Mesh Repair of Rectocele: A Randomized Trial

  • Sezai Leventoğlu

Turk J Colorectal Dis 2007;17(1):9-15


The aim of this study was to compare in a prospective, randomized fashion the clinical results of site-specific fascial repair and polypropylene mesh repair of rectocele in a selected group of patients with isolated posterior vaginal wall prolapse.


Sixty consecutive women with isolated, symptomatic stage II or stage III rectocele were randomized to undergo transperineal site-specific fascial suture repair or transperineal mesh repair of rectocele. No additional interventions, including levatoroplasty or perineorraphy, were performed.


Both surgical methods resulted in significant improvements in the symptom scores of vaginal digitation, straining, incomplete evacuation, and vaginal lump. Comparing the postoperative symptom scores of the two groups, the 0 postoperative score of vaginal digitation in the mesh repair group was significantly lower than that of the fascial repair group (p=0.004), while the other postoperative symptom scores were similar. Objective evaluation of anatomic repair revealed that 69.2 percent of women in the fascial repair group and 89.3 percent of women in the mesh repair group had surgical cure (p= 0.095). The 92.9 percent patient satisfaction rate in the mesh repair group was higher than that in the fascial repair group (69.2 percent; p=0.037). Mesh repair was associated with an insignificantly higher rate of surgical complications (25.0 percent), compared with fascial repair (15.4 percent; p=0.505) Graft rejection occurred in a single patient and graft protrusion in another. The rates of postoperative dyspareunia were similar (p=0.725).


Our results suggest that both surgical methods are effective in significantly reducing symptoms of rectocele and recreation of normal anatomy. Compared with fascial repair, mesh repair of rectocele was more successful in eliminating vaginal digitation, and it was followed by a higher rate of patient satisfaction. These advantages of mesh repair were associated with an insignificantly higher rate of surgical complications, some of which were unique to the use of polypropylene graft.

Keywords: ectocele, surgery, transperineal, mesh