Transvaginal rectocele repair with human dermal allograft interposition and bilateral sacrospinous fixation with a minimum eight-year follow-up

BACKGROUND: Human dermal allografts have been used for over a decade for interpositional repair of rectoceles. How do dermal allografts perform with regards to success rate and complications with 8 years’ minimum follow-up? METHODS: We retrospectively reviewed 41 consecutive patients undergoing dermal allograft interposition procedures between October 2001 and December 2005 (Repliform, Boston Scientific, Natick, MA, USA) for stage two, three, and four International Continence Society (ICS) symptomatic rectocele repairs with bilateral sacrospinous fixation. Failure was defined as recurrent stage two International Continence Society prolapse (Ap ≥ −1 and/or Bp ≥ −1). All questionnaires were completed 1 week before surgery and at follow-up (September 2014 through December 2014). RESULTS: The mean preoperative and postoperative A(p) were 0.95 ± 0.70,−1.90 ± 0.52 and B(p) 1.30 ± 0.84,−2.13 ± 0.51 (p < 0.001). With a mean follow-up of 116.5 ± 18.9 months, a success rate of 73 % (30/41) was achieved, with anatomical reduction of prolapse. For splinting and digitations, an 82 % cure rate was realized. The Pelvic Floor Distress Inventory (PFDI) pre- and post-operative results showed significant improvement (p < 0.001). There were two incisional exposures (5 %). Seventy percent of patients were secondary repairs while 30 % were primary repairs (81 % success rate, p < 0.36). One patient experienced nerve entrapment and subsequent unilateral takedown. Patient satisfaction was 77 %. CONCLUSIONS: Our retrospective study approaching long-term results demonstrated that symptomatic rectocele procedures with human dermal allograft interposition provide an effective anatomical and functional repair with acceptable complication rates.