Rectocele repair: a randomized trial of three surgical techniques including graft augmentation.
OBJECTIVE
This study was undertaken to compare outcomes of 3 different rectocele repair techniques.


METHODS
One hundred six women with stage II or greater posterior vaginal wall prolapse were randomly assigned to either posterior colporrhaphy (n = 37), site-specific rectocele repair (n = 37), or site-specific rectocele repair augmented with a porcine small intestinal submucosa graft (Fortagen, Organogenesis, Inc, Canton, MA; n = 32). Subjects underwent a physical examination and completed 3 validated pelvic floor instruments at baseline and 6 months, 1 year, and 2 years after surgery. Anatomic failure was defined as pelvic organ prolapse quantitation system (POPQ) point Bp > or = -2 at 1 year.


RESULTS
Of 106 subjects who enrolled, 105 underwent surgery and of those 105, 98 subjects returned (93%) with a mean follow-up of 17.5 +/- 7 months. After 1 year, those subjects who received graft augmentation had a significantly greater anatomic failure rate (12/26; 46%) than those who received site-specific repair alone (6/27; 22%) or posterior colporraphy (4/28; 14%), P = .02. There was a significant improvement in prolapse and colorectal scales and overall summary scores of the Pelvic Floor Distress Inventory short form 20 (PFDI-20), the Pelvic Floor Impact Questionnaire short form 7 (PFIQ-7) after surgery in all groups (P < .001 for each) with no differences between groups. The proportion of subjects with functional failures was 15% overall, and not significantly different between groups. There was no significant change in the rate of dyspareunia 1 year after surgery and there were no differences between groups. Overall sexual function as measured by the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire short form (PISQ-12) improved significantly in all groups postoperatively (P < . 001), with no differences between groups.


CONCLUSIONS
Posterior colporraphy and site-specific rectocele repair result in similar anatomic and functional outcomes. The addition of a porcine-derived graft does not improve anatomic outcomes. All 3 methods of rectocele repair result in significant improvements in symptoms, quality of life, and sexual function.
Paraiso
Marie Fidela R
MF
Cleveland Clinic, Cleveland, OH, USA.
Barber
Matthew D
MD
Muir
Tristi W
TW
Walters
Mark D
MD
D000368:Aged; D000818:Animals; D001705:Bioprosthesis; D005260:Female; D005500:Follow-Up Studies; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D007413:Intestinal Mucosa / Q000637:transplantation*; D008875:Middle Aged; D011184:Postoperative Period; D011788:Quality of Life; D020047:Rectocele / Q000150:complications* / Q000601:surgery*; D019529:Sexuality; D011795:Surveys and Questionnaires; D013552:Swine; D016896:Treatment Outcome; D014596:Uterine Prolapse / Q000150:complications* / Q000601:surgery*