Transperineal rectocele repair with porcine dermal collagen implant. A two-year clinical experience

Rectocele is an herniation of the rectum through the rectovaginal fascia and posterior vaginal wall causing a protrusion into the vaginal lumen. It’s a common disorder in women with history of multiple vaginal deliveries and it is asymptomatic in 80% of cases. Symptomatic rectocele is less common, usually affects postmenopausal females, and results in obstructed defecation and constipation. Surgery should be considered when conservative therapy fails and a careful patient selection, based on an accurate morpho-functional assessment, is crucial to obtain a satisfactory outcome1,2. The purpose of surgical repair in the management of rectocele repair are essentially the restoration of normal vaginal anatomy and the restoration or maintenance of normal bladder, bowel, and sexual function1,2. Transperineal repair of the fascial defect may provide restoration of normal anatomy and symptomatic relief. A variety of both synthetic and nonsynthetic graft materials have been used in the rectocele repair to enhance anatomical and functional results and improve long-term outcomes. Recent advances in pelvic reconstructive surgery are due in part to the availability of new graft materials that allow reinforcement and repair of large pelvic fascial defects minimizing adverse graft-related effects and infections. Porcine acellular collagen matrix (Permacol) seems to relief symptoms minimizing postoperative complications1-5. This prospective study was designed to assess the short and medium-term outcomes and the safety of transperineal rectocele repair with an acellular porcine dermal collagen implant (Permacol®) in a cohort of 10 women with symptomatic rectocele after medical treatment failure.