Dermal graft-augmented rectocele repair

Abstract

We describe a new technique in the surgical treatment of rectocele using a dermal allograft to augment site-specific fascial defect repair of the rectovaginal fascia. The posterior vaginal wall is opened and discrete defects in the rectovaginal fascia are repaired in a site-specific fashion using delayed absorbable suture. A second layer of support is created using a rectangular dermal allograft placed over the site-specific repair and secured to the normal anatomic attachments of the rectovaginal fascia using permanent sutures. The vagina is then closed and routine perineorrhaphy performed as indicated. Forty-three women with advanced posterior vaginal wall prolapse underwent dermal graft augmentation of site-specific rectocele repair over a 1-year period. No major intraoperative or postoperative complications were reported. Thirty women were available for follow-up examination at an average of 12.9 months (range 8–17). The average patient age in the follow-up group was 63.6 ± 10.9 years (range 33–79) and average parity was 2.8 ± 1.5 (range 0–7). Using the Pelvic Organ Prolapse Quantification score, the average measurement of point A_p was 0.25 preoperatively and −2.4 postoperatively, whereas point B_p was 0.9 preoperatively and −2.5 postoperatively. Using a point A_p measurement of −0.5 or greater to define surgical failure, 28/30 (93%) of women were noted to have surgical cure on follow-up. Site-specific rectocele repair augmented with dermal allograft is associated with high cure rates and minimal complications. It recreates normal anatomic support and is easily adapted into current surgical procedures for rectocele repair.