Functional and anatomic outcome after transvaginal rectocele repair using collagen mesh: a prospective study.
OBJECTIVE
This study was designed to evaluate rectocele repair using collagen mesh.


METHODS
32 female patients underwent surgical repair using collagen mesh. Outcome was assessed in 29 patients and preoperative assessment included standardized questionnaire, clinical examination, and defecography. At the six-month follow-up, patients answered a standardized questionnaire and underwent clinical examination. At the 12-month follow-up, patients answered a standardized questionnaire, underwent clinical examination, and defecography.


RESULTS
Preoperatively, 26 patients had a Stage II and 3 patients had a Stage III rectocele. At the 6-month follow-up, five patients had rectocele > or = Stage II (P < 0.001) and at the 12-month follow-up, seven patients had rectocele > or = Stage II (P < 0.001) at clinical examination. At the preoperative defecography, all patients presented a rectocele. At the 12-month defecography, 14 patients had no rectocele (P < 0.001) and 15 had a rectocele. At the six-month follow-up, there was a significant decrease in rectal emptying difficulties, need of digital support of the posterior vaginal wall at defecation, and defecation frequency. At the 12-month follow-up, symptom improvement remained, but was less pronounced.


CONCLUSIONS
Rectocele repair using collagen mesh improved anatomic support, but there is a substantial risk for recurrence with unsatisfactory anatomic and functional outcome one year after surgery. Rectocele repair using mesh was not associated with an increased risk of dyspareunia. Rectocele repair using biomaterial mesh reinforcement needs further evaluation before adopted into clinical practice.
Altman
Daniel
D
Division of Obstetrics and Gynecology, Pelvic Floor Center, Karolinska Institutet Danderyd Hospital, Stockholm, Sweden. daniel.altman@ds.se
Zetterström
Jan
J
López
Annika
A
Anzén
Bo
B
Falconer
Christian
C
Hjern
Fredrik
F
Mellgren
Anders
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001672:Biocompatible Materials; D003094:Collagen; D019841:Defecography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D020047:Rectocele / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D012007:Rectum / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D013526:Surgical Mesh; D016896:Treatment Outcome
D001672:Biocompatible Materials; D003094:Collagen