Critical thresholds of combined transvaginal mesh and transanal resection for rectocele repair in East Asian women
Year: 2026
Type: editorial
Abstract: This study aimed to establish rectocele severity thresholds for East Asian populations using defecography, examine associations between rectocele morphology and symptoms of obstructive defecation syndrome, compare the 3-year efficacy and safety of transvaginal mesh with transanal resection versus tissue-selecting therapy stapler procedure, and identify predictors of postoperative constipation, recurrence, and reoperation. A prospective cohort study (2019–2024), included total of 138 women with rectocele-associated obstructive defecation syndrome at Tianjin Union Medical Center. Transvaginal mesh combined with transanal resection versus tissue-selecting therapy stapler procedure was performed. Primary outcomes were rectocele morphology classification using Li-Geng angle quantification, identification of concomitant pelvic floor lesions on defecography for R 11 confirmation, and severity thresholds derived from receiver operating characteristic analysis. Secondary outcomes were surgical safety (complication rates) and effectiveness (Wexner constipation score >12) at a median 3-year follow-up. Four rectocele morphologies were identified: funnel (12.3%), pouch (57.2%), boot-shaped (27.5%), and papillary types (2.9%). Severe rectocele was defined as depth ≥30.5 mm or distance between anorectal junction and pubococcygeal line (≥37.5 mm), with high diagnostic accuracy. Threshold for the combined procedure included depth ≥22.5 mm and Li-Geng angle ≤81.5°. Compared with stapler procedure, the combined approach was associated with significantly lower long-term morbidity ( P =0.01), lower recurrence ( P =0.01), and reduced reoperation rates ( P =0.03). The R 11 phenotype independently predicted postoperative constipation recurrence ( P =0.02). The combined approach provided superior long-term outcomes compared with stapler procedure. The R 11 phenotype may help identify patients at high risk of postoperative constipation recurrence and support personalized surgical strategies.
Source: Current Problems in Surgery
Authors: Hong Zhi Geng, Chen Xu, Jiying Cong, Xu Yang, Yuwei Li
Language: English
Subfield: Rheumatology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,780
OpenAlex ID: W7130821656