Native-tissue repair of isolated primary rectocele compared with nonabsorbable mesh: patient-reported outcomes
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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.
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.
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.
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.
KeywordsColporrhaphy National register data Non absorbable mesh Patient-reported outcome Rectocele
The Swedish Association of Local Authorities and Regions supported this study.
LD Madsen: data setup and analysis, statistical analysis, writing process.
Compliance with ethical standards
All women were informed that they could decline to participate in The Swedish National Register for Gynaecological Surgery. This study was approved by the Ethics Committee University of Umeå, Sweden (Dnr 08–076 M).
Conflicts of interest
The authors alone are responsible for the content and writing of the paper.
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