Sam Kuykendall, MD, Gary Leach, MD, Los Angeles, CA
OBJECTIVES: After the recent FDA statements, mesh alternatives for pelvic organ prolapse repair are at the forefront. Since our initial description of rectocele repair using nonfrozen cadaveric fascia lata interposition (CaRS) in 2005, we have continued to perform rectocele repair utilizing the same technique. Our objective is to present the updated and long-term data for the repair of rectocele with non-frozen cadaveric fascia lata as an alternative to mesh in light of the controversy.
METHODS: patients, aged to , with symptomatic rectoceles underwent repair with CaRS. Concomitant pelvic organ prolapse repairs were included in the study. A retrospective chart review with physical exam was performed on all patients. Outcomes measured included recurrence defined as any rectocele on physical exam, complications, patient satisfaction including improvement in symptoms, and sexual function.
RESULTS: A total of patients with an average age of at the time of surgery were evaluated with an average followup of . Recurrence, defined as any rectocele on physical exam, was %. Of the patients, % denied postoperative stool trapping requiring splinting. Of the sexually active patients, % experienced de novo dyspareunia and patients were able to become sexually active after their rectocele was repaired. Our complication rate was % including wound separation and granulation, all of which healed with conservative management. Patient satisfaction was based upon subjective improvement from 1-100 with average being % in our study.
CONCLUSIONS: Use of nonfrozen cadaveric fascia for rectocele repair is an excellent alternative to mesh repair with less denovo dyspareunia and good long-term durability. Fascial interposition prevents vaginal narrowing and decreases dyspareunia and postoperative pain. With an average followup of , patient satisfaction remains very high with a low rate of recurrence.