title: Native-tissue repair of isolated primary rectocele compared with nonabsorbable mesh: patient-reported outcomes.
abstract: BACKGROUND
  We evaluated patient-reported outcomes and complications after treatment of isolated primary rectocele in routine health-care settings using native-tissue repair or nonabsorbable mesh.
  
  
  METHODS
  We used prospective data from the Swedish National Register for Gynaecological Surgery and included 3988 women with a primary operation for rectocele between 2006 and 2014: 3908 women had native-tissue repair, 80 were operated with nonabsorbable mesh. No concurrent operations were performed. Pre- and perioperative data were collected from doctors and patients. Patient-reported outcomes were evaluated 2 and 12 months after the operation. Only validated questionnaires were used.
  
  
  RESULTS
  One year after native-tissue repair, 77.8 % (76.4-79.6) felt they were cured, which was defined as never or hardly ever feeling genital protrusion; 74.0 % (72.2-75.7) were very satisfied or satisfied, and 84 % (82.8-85.9) reported improvement of symptoms. After mesh repair, 89.8 % (77.8-96.6) felt cured, 69.2 % (54.9-81.3) were very satisfied or satisfied, and 86.0 % (72.1-94.7) felt improvement. No significant differences were found between groups. Organ damage was found in 16 (0.4 %) patients in the native-tissue repair group compared with one (1.3 %) patient in the mesh group [odds ratio (OR) 3.08; 95 % confidence interval (CI) 0.07-20.30]. The rate of de novo dyspareunia after native-tissue repair was 33.1 % (30.4-35.8), comparable with that after mesh repair. The reoperation rate was 1.1 % (0.8-1.5) in both groups.
  
  
  CONCLUSIONS
  Most patients were cured and satisfied after native-tissue repair of the posterior vaginal wall, and the patient-reported outcomes were comparable with results after mesh repair. The risk of serious complications and reoperation were comparable between groups.
authors.affiliation: Department of Obstetrics and Gynecology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200, Aarhus N, Denmark. lduchm@gmail.com.
authors.forename: Lene Duch
authors.initials: LD
authors.lastname: Madsen
authors.affiliation: Department of Clinical Science, Obstetrics and Gynecology, Umeå University, 901 87, Umeå, Sweden.
authors.forename: Emil
authors.initials: E
authors.lastname: Nüssler
authors.affiliation: Department of Obstetrics and Gynecology, Herlev University Hospital, Herlev Ringvej 75, DK-2730, Herlev, Denmark.
authors.forename: Ulrik Schiøler
authors.initials: US
authors.lastname: Kesmodel
authors.affiliation: Department of Obstetrics and Gynecology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200, Aarhus N, Denmark.
authors.forename: Susanne
authors.initials: S
authors.lastname: Greisen
authors.affiliation: Department of Obstetrics and Gynecology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200, Aarhus N, Denmark.
authors.forename: Karl Møller
authors.initials: KM
authors.lastname: Bek
authors.affiliation: Department of Obstetrics and Gynecology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200, Aarhus N, Denmark.
authors.forename: Marianne
authors.initials: M
authors.lastname: Glavind-Kristensen
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D000071066:Patient Reported Outcome Measures; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000209:etiology / Q000523:psychology*; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods / Q000523:psychology*; D020047:Rectocele / Q000523:psychology / Q000601:surgery*; D012042:Registries; D018709:Statistics, Nonparametric; D013526:Surgical Mesh; D011795:Surveys and Questionnaires; D013548:Sweden; D016896:Treatment Outcome; D014596:Uterine Prolapse / Q000523:psychology / Q000601:surgery*; D014621:Vagina / Q000601:surgery*
keywords: Colporrhaphy; National register data; Non absorbable mesh; Patient-reported outcome; Rectocele