Functional outcome after transperineal rectocele repair with porcine dermal collagen implant.
OBJECTIVE
Symptomatic rectocele results in obstructed defecation and constipation. Surgical repair may provide symptomatic relief. This study was designed to assess the safety and efficacy of transperineal rectocele repair with porcine dermal collagen (Permacol).


METHODS
Ten females with symptomatic rectocele had a transperineal repair using Permacol. Median age was 51 (range, 33-71) years. Patients were followed with detailed interviews at a median time of 9 (range, 5-16) months. Objective preoperative and postoperative assessment was by outcomes for five symptoms: constipation, excessive straining, incomplete evacuation, vaginal bulging, and vaginal digitations (always, usually, occasionally, never), and Medical Outcomes Study Short Form 36 questionnaires. Subjective outcomes were assessed as excellent, good, moderate, and poor.


RESULTS
All patients had an improvement in two or more symptoms and 70 percent of patients in three or more symptoms. Postoperatively 80 percent reported an improvement in excessive straining (P = 0.0078) and in incomplete evacuation (P = 0.0078); 70 percent reported an improvement in vaginal bulging (P = 0.0156). Improvements in vaginal digitations and Medical Outcomes Study Short Form 36 scores were not statistically significant. Subjective outcomes were reported as excellent or good by 80 percent of patients. No patients had rectal perforation or infection, and no Permacol has been removed.


CONCLUSIONS
Rectocele repair with Permacol((R)) by the transperineal approach is a safe technique that avoids some of the complications associated with synthetic mesh use. Objective and subjective results are excellent in the majority of patients.
Smart
Neil J
NJ
Department of Surgery, Southmead Hospital, North Bristol NHS Trust, Westbury-on-Trym, Bristol, UK. drneilsmart@hotmail.com
Mercer-Jones
Mark A
MA
D000328:Adult; D000368:Aged; D000818:Animals; D001672:Biocompatible Materials; D003094:Collagen; D003248:Constipation / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D003672:Defecation / Q000502:physiology; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D010537:Peritoneum; D019919:Prosthesis Implantation / Q000295:instrumentation*; D020047:Rectocele / Q000150:complications / Q000601:surgery*; D011795:Surveys and Questionnaires; D013997:Time Factors; D014183:Transplantation, Heterologous; D016896:Treatment Outcome
D001672:Biocompatible Materials; C422414:Permacol; D003094:Collagen