Rectocele repair using biomaterial augmentation: current documentation and clinical experience.
Although the etiology of rectocele remains debated, surgical innovations are currently promoted to improve anatomic outcome while avoiding dyspareunia and alleviating rectal emptying difficulties following rectocele surgery. Use of biomaterials in rectocele repair has become widespread in a short time, but the clinical documentation of their effectiveness and complications is limited. Medline and the Cochrane database were searched electronically from 1964 to May 2005 using the Pubmed and Ovid search engines. All English language publications including any of the search terms "rectocele," "implant," "mesh," "biomaterial," "prolapse," "synthetical," "pelvic floor," "biological," and "compatibility" were reviewed. This review outlines the basic principles for use of biomaterials in pelvic reconstructive surgery and provides a condensation of peer-reviewed articles describing clinical use of biomaterials in rectocele surgery. Historical and new concepts in rectocele surgery are discussed. Factors of importance for human in vivo biomaterial compatibility are presented together with current knowledge from clinical studies. Potential risks and problems associated with the use of biomaterials in rectocele and pelvic reconstructive surgery in general are described. Although use of biomaterials in rectocele and other pelvic organ prolapse surgery offers exciting possibilities, it raises treatment costs and may be associated with unknown and potentially severe complications at short and long term. Clinical benefits are currently unknown and need to be proven in clinical studies.


BACKGROUND
Obstetricians & Gynecologists, Family Physicians


BACKGROUND
After completion of this article, the reader should be able to explain that the objective of surgical treatment is to improve anatomic outcome and alleviate rectal emptying difficulties, describe the efficacy of biomaterials in rectocele repair, and summarize the potential risks and problems associated with use of biomaterials in rectocele and pelvic reconstructive surgery.
Altman
Daniel
D
Pelvic Floor Center, Division of Obstetrics and Gynecology, The Karolinska Institute at Danderyd Hospital, 182-88 Stockholm, Sweden. daniel.altman@ds.se
Mellgren
Anders
A
Zetterström
Jan
J
D001672:Biocompatible Materials / Q000009:adverse effects; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D019919:Prosthesis Implantation / Q000379:methods; D019651:Plastic Surgery Procedures / Q000379:methods; D020047:Rectocele / Q000601:surgery*; D013526:Surgical Mesh; D016896:Treatment Outcome
D001672:Biocompatible Materials