Purpose
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® 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.
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References
PJ Shorvon S McHugh NE Diamant S Somers GW Stevenson (1989) ArticleTitleDefecography in normal volunteers: results and implications Gut 30 1737–1749 Occurrence Handle2612988 Occurrence Handle10.1136/gut.30.12.1737 Occurrence Handle1:STN:280:By%2BC38fktFU%3D
AC Richardson (1993) ArticleTitleThe rectovaginal septum revisited: its relationship to rectocele and its importance in rectocele repair Clin Obstet Gynecol 36 976–983 Occurrence Handle8293598 Occurrence Handle10.1097/00003081-199312000-00022 Occurrence Handle1:STN:280:ByuC38zkvVU%3D
Maher C, Baessler K, Glazener CM, Adams EJ, Hagen S. Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev 2004 (Oct 18);4:CD004014
YH Ho M Ang D Nyam M Tan F Seow-Choen (1998) ArticleTitleTransanal approach to rectocele repair may compromise anal sphincter pressures Dis Colon Rectum 41 354–358 Occurrence Handle9514432 Occurrence Handle10.1007/BF02237491 Occurrence Handle1:STN:280:DyaK1c7ntleltQ%3D%3D
MA Kahn SL Stanton (1997) ArticleTitlePosterior colporrhaphy: its effects on bowel and sexual function Br J Obstet Gynaecol 104 82–86 Occurrence Handle8988702 Occurrence Handle1:STN:280:ByiC2c3mvVQ%3D
JR Dell KR O’Kelley (2005) ArticleTitlePelviSoft BioMesh augmentation of rectocele repair: the initial clinical experience in 35 patients Int Urogynecol J Pelvic Floor Dysfunct 16 44–47 Occurrence Handle15340802 Occurrence Handle10.1007/s00192-004-1217-x
N Kohli J Miklos (2003) ArticleTitleDermal graft-augmented rectocele repair Int Urogynecol J Pelvic Floor Dysfunct 14 146–149 Occurrence Handle12851761 Occurrence Handle10.1007/s00192-002-1013-4 Occurrence Handle1:STN:280:DC%2BD3szitVKgtQ%3D%3D
SJ Watson PB Loder S Halligan CI Bartram MA Kamm RK Phillips (1996) ArticleTitleTransperineal rectocele repair of symptomatic rectocele with marlex mesh: a clinical, physiological and radiological assessment of treatment J Am Coll Surg 183 257–261 Occurrence Handle8784320 Occurrence Handle1:STN:280:BymA2sfnsFM%3D
JP Lechaux D Lechaux P Bataille I Bars (2004) ArticleTitleTransperineal repair of rectocele with prosthetic mesh. A prospective study Ann Chir 129 211–217 Occurrence Handle15191847 Occurrence Handle10.1016/j.anchir.2004.03.006 Occurrence Handle1:STN:280:DC%2BD2czjsFejsw%3D%3D
MA Mercer-Jones A Sprowson JS Varma (2004) ArticleTitleOutcome following transperineal mesh repair of rectocele: a case series Dis Colon Rectum 47 864–868 Occurrence Handle15085441 Occurrence Handle10.1007/s10350-004-0526-y Occurrence Handle1:STN:280:DC%2BD2c3ntVGrsA%3D%3D
JM Hanson B Aspin LJ Spalding JS Varma (2004) ArticleTitleTransperineal repair of rectocele using porcine collagen Colorectal Dis 6 IssueIDSuppl 1 36
C Maher K Baessler (2006) ArticleTitleSurgical management of posterior vaginal wall prolapse: an evidence-based literature review Int Urogynecol J Pelvic Floor Dysfunct 17 84–88 Occurrence Handle15838586 Occurrence Handle10.1007/s00192-005-1295-4
C Harper (2001) ArticleTitlePermacol: clinical experience with a new biomaterial Hosp Med 62 90–95 Occurrence Handle11236624 Occurrence Handle1:STN:280:DC%2BD3M7otleluw%3D%3D
H Gallagher (2005) ArticleTitleThe use of biological grafts in infected hernia fields Hernia 9 SI85–SI86
D Altman A Mellgren B Blomgren A Lopez J Zetterstrom J Nordenstam (2004) ArticleTitleClinical and histological safety assessment of rectocele repair using collagen mesh Acta Obstet Gynecol Scand 83 995–1000 Occurrence Handle15453901 Occurrence Handle10.1111/j.0001-6349.2004.00646.x
D Altman J Zetterstrom A Mellgren C Gustafsson B Anzen A Lopez (2006) ArticleTitleA three year prospective assessment of rectocele repair using porcine xenograft Obstet Gynecol 107 59–65 Occurrence Handle16394040
D Altman J Zetterstrom A Lopez et al. (2005) ArticleTitleFunctional and anatomic outcome after transvaginal rectocele repair using collagen mesh: a prospective study Dis Colon Rectum 48 1233–1242 Occurrence Handle15868220 Occurrence Handle10.1007/s10350-005-0023-y
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Smart, N.J., Mercer-Jones, M.A. Functional Outcome After Transperineal Rectocele Repair with Porcine Dermal Collagen Implant. Dis Colon Rectum 50, 1422–1427 (2007). https://doi.org/10.1007/s10350-007-0219-4
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DOI: https://doi.org/10.1007/s10350-007-0219-4