Surgical Treatments for Rectocele in Adult Women: A Systematic Review and Meta-analysis

Öz

Objective: This systematic review and meta-analysis aimed to compare the effectiveness and safety of major surgical interventions used for rectocele repair in adult women and to synthesize contemporary evidence on anatomical, functional, and patient-reported outcomes. Methods: Following PRISMA 2020 guidelines, studies published between 1998 and 2025 were searched across major databases. Eligible designs included RCTs, prospective/retrospective cohorts, and case series (>10 patients) reporting rectocele-specific outcomes with ≥12 months of follow-up. Forty-five studies met inclusion criteria (12 RCTs, 33 observational), and 20 were included in meta-analysis. Primary outcomes were anatomical success, resolution of obstructed defecation syndrome (ODS), recurrence, and reoperation; secondary outcomes included mesh-related complications, dyspareunia, fecal incontinence, and de novo constipation. Results: Meta-analysis demonstrated significantly lower anatomical recurrence after transvaginal native tissue repair compared with transanal repair (pooled RR ≈ 0.25). Mesh augmentation for posterior compartment prolapse did not improve subjective or objective outcomes and was associated with mesh exposures (5–10%). STARR provided substantial short-term ODS improvement (70–90% of patients) but showed notable long-term recurrence (20–30%) and reintervention rates (~20%). Laparoscopic ventral mesh rectopexy (LVMR) offered the most durable improvement, with 80–95% symptom relief and low recurrence and complication rates, particularly in patients with internal rectal prolapse or multicompartment defects. Conclusion: Native tissue posterior colporrhaphy remains the first-line surgical treatment for symptomatic rectocele. STARR is beneficial for selected ODS-dominant patients but lacks long-term durability. Mesh use in the posterior compartment offers no meaningful benefit and carries additional risks; therefore, it should not be routinely used. Ventral mesh rectopexy demonstrates superior functional outcomes in complex cases and is an effective option for women with combined rectocele and internal rectal prolapse. Optimal management should be individualized and anatomically guided.

Anahtar Kelimeler

• Pelvic floor surgery
• Ventral mesh rectopexy
• STARR
• Rectocele
• Posterior vaginal wall prolapse
• Obstructed defecation syndrome

Erişkin Kadınlarda Rektosele Cerrahi Yaklaşımlar: Sistematik Derleme ve Meta-Analiz

Öz

Amaç: Bu sistematik derleme ve meta-analizin amacı, erişkin kadınlarda rektocele bağlı semptomların cerrahi tedavisinde kullanılan başlıca yöntemleri karşılaştırmak ve güncel literatür doğrultusunda etkinlik–güvenlik profillerini değerlendirmektir. Yöntem: PRISMA 2020 kılavuzuna uygun olarak 1998–2025 yılları arasında yayımlanmış çalışmalar tarandı. Dahil etme kriterleri erişkin kadın popülasyonu, rektocele için uygulanan cerrahi girişim, ≥12 ay takip ve ≥10 hasta içeren çalışma tasarımları idi. Toplam 45 çalışma (12 RCT, 33 gözlemsel) analiz edildi; 20 çalışma meta-analize dahil edildi. Temel sonuçlar anatomik başarı, obstrüktif defekasyon sendromu (ODS) düzelmesi, rekürrens ve reoperasyon oranları; ikincil sonuçlar ise meş komplikasyonları, disparoni, fekal inkontinans ve de novo konstipasyondu. Bulgular: Meta-analiz, transvajinal posterior kolporafinin transanal onarıma göre anlamlı derecede daha düşük rekürrens oranı sunduğunu göstermiştir (RR ≈ 0.25). Meş ile güçlendirilmiş posterior onarım, yerli doku tamirine göre belirgin bir avantaj sağlamamış; buna karşın meş erozyonu ve ağrı gibi komplikasyonlar %5–10 oranlarında görülmüştür. STARR, kısa dönemde ODS semptomlarını belirgin biçimde azaltmasına rağmen, uzun dönemde rekürrens ve yeniden müdahale gereksinimi %20–30 düzeyine ulaşmıştır. Laparoskopik ventral meş rektopeksi; ODS, intussusepsiyon ve çoklu kompartman prolapsusu olan hastalarda %80–95 iyileşme oranları ve düşük komplikasyon profili ile en güçlü seçeneklerden biri olarak öne çıkmıştır. Sonuç: Erişkin kadınlarda rektocele tedavisinde yerli doku posterior kolporafi çoğu hasta için birinci basamak cerrahi olmaya devam etmektedir. STARR seçilmiş ODS-dominant hastalarda etkili olmakla birlikte, uzun dönem başarısı sınırlıdır. Posterior kompartmanda meş kullanımı anlamlı fayda sağlamadığından önerilmemektedir. Ventral meş rektopeksi, karmaşık veya çoklu prolapsuslu hastalarda üstün fonksiyonel sonuçlar sunmaktadır. Tedavi kararı mutlaka bireyselleştirilmeli, anatomi–fonksiyon ilişkisi bütüncül olarak değerlendirilmelidir.

Anahtar Kelimeler

• rektosel
• Posterior vajinal duvar prolapsusu
• Obstrüktif defekasyon sendromu
• Posterior kolporafi
• STARR
• Ventral meş rektopeksi
• Pelvik taban cerrahisi

Kaynakça

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