Initial experience with rectocele repair using nonfrozen cadaveric fascia lata interposition

Objectives. To describe a rectocele repair reinforced with solvent-dehydrated, gamma-irradiated, human fascia lata and report our early results with a technique we are confident will have a greater, more durable success rate, with a lower incidence of dyspareunia, than the classic repair. Methods. A total of 73 patients, aged 31 to 86 years, with symptomatic (stool trapping and/or vaginal/perineal splinting or postural modifications to facilitate stool evacuation) rectoceles underwent a site-specific repair reinforced with cadaveric fascia. Perioperative questionnaires, retrospective chart review, and telephone interview by a blinded third-party reviewer and physical examination was conducted. Issues thought to be relevant to the rectocele repair were assessed. Results. Of the 73 patients, 62 responded to the postoperative questionnaire and 50 underwent physical examination. The mean follow-up was 13.7 months (range 6 to 23). Of the 62 patients, 52 (93.6%) denied postoperative stool trapping requiring vaginal/perineal splinting. Of the 39 sexually active patients, 4 (10.3%) experienced de novo dyspareunia. Minor complications were seen in 15 patients (24%). One developed a symptomatic enterocele. Conclusions. Interposition of cadaveric fascia lata avoids dependence on weakened native rectovaginal support to facilitate the rectocele repair. Our technique uses fascial interposition, rather than obliteration of the defect, preventing vaginal narrowing, and should thereby decrease the incidence of dyspareunia. Patient symptom improvement and satisfaction rates were competitive with those after traditional rectocele repair. Follow-up is ongoing with the hope that the fascial reinforcement will translate into more durable results.