CASE REPORT
Advantages of implantation of acellular porcine-derived mesh in the treatment of human rectocele – Case report
 
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1
Department of General, Endocrine and Gastroenterological Oncology Surgery, Poznan University of Medical Sciences, Poznan, Poland
2
Division of Gynecological Surgery, Poznan University of Medical Sciences, Poznan, Poland
CORRESPONDING AUTHOR
Sebastian Szubert   

Division of Gynecological Surgery, Poznan University of Medical Sciences, Poznan, Poland
 
Ann Agric Environ Med. 2016;23(4):692–695
KEYWORDS
ABSTRACT
Introduction:
A rectocele is a hernation of the rectum into the vaginal lumen developing as a consequence of weakness of the rectovaginal septum. It affects about 18% of women after childbearing age. Symptoms associated with a rectocele include constipation, vaginal fullness or heaviness, feeling of a bulging mass within vagina, incomplete stool evacuation and dyspareunia. Current methods of surgical treatment of a rectocele often require implantation of a mesh graft. In most of cases, synthetic and non-absorbable meshes are used. Although implantation of a synthetic and non-absorbable mesh is effective in the treatment of rectocele, a high rate of mesh erosion has been reported.

Case report:
This study presents a surgical technique and case report for the treatment of a rectocele in a 46-year-old women by implantation of a porcine-derived absorbable collagen mesh (Pelvicol®) by transvaginal approach, with six year follow-up. A review of the literature concerning implantation of Pelvicol® for the treatment of rectocele was also undertaken.

Conclusions:
The clinical experience and review of the literature by the authors suggest that a porcine-derived acellular mesh is non-cytotoxic, pyrogenic or allergenic, and the application of a biomesh in the management of rectocele is effective and safe, and the risk of mesh erosion is very low.

 
REFERENCES (21)
1.
Hendrix SL, Clark A, Nygaard I, Barnabei V, McTiernan A. Pelvic organ prolapse in the Women’s Health Initiative: gravity and gravidity. Am J Obstet Gynecol. 2002; 186: 1160–1166.
 
2.
Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL. Epidemiology of surgically managed pelvic organ prolapsed and urinary incontinence. Obstet Gynecol. 1997; 89: 501–506.
 
3.
Whiteside JL, Weber AM, Meyn LA, Walters MD. Risk factors for prolapse recurrence after vaginal repair. Am J Obstet Gynecol. 2004; 191: 1533–15388.
 
4.
Julian TM. Posterior Compartment Defects. In: Rock JA, Howard WJ. Te Linde’s Operative Gynecology, 10th Edition, Lippincott Williams & Wilkins, 2008.p.893–910.
 
5.
Berman L, Aversa J, Abir F, Longo WE. Management of disorders of the posterior pelvic floor. Yale J Biol Med. 2005 Jul; 78(4): 211–221.
 
6.
Maher C, Baessler K, Glazener CM, Adams EJ, Hagen S. Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev. 2004; 4:CD004014.
 
7.
Richter HE, Verner RE., Pelvic Organ Prolapse. In: Berek JS., Berek & Novak’s Gynecology, 14th Edition, Lippincott Williams & Wilkins, 2007.p.898–934.
 
8.
Cundiff GW, Fenner D. Evaluation and treatment of women with rectocele: focus on associated defecatory and sexual dysfunction. Obstet Gynecol. 2004 Dec; 104(6): 1403–1421.
 
9.
Milito G, Cadeddu F, Selvaggio I, Grande M, Farinon AM. Transperineal rectocele repair with porcine dermal collagen implant. A two-year clinical experience. Pelviperineology 2010; 29: 76–78.
 
10.
Gaertner WB, Bonsack ME, Delaney JP. Experimental evaluation of four biologic prostheses for ventral hernia repair. J Gastrointest Surg. 2007 Oct; 11(10): 1275–1285.
 
11.
Zheng F, Lin Y, Verbeken E, Claerhout F, Fastrez M, De Ridder D, et al. Host response after reconstruction of abdominal wall defects with porcine dermal collagen in a rat model. Am J Obstet Gynecol. 2004 Dec; 191(6): 1961–1970.
 
12.
Smart NJ, Bryan N, Hunt JA. A scientific evidence for the efficacy of biologic implants for soft tissue reconstruction. Colorectal Dis. 2012 Dec; 14 Suppl 3: 1–6.
 
13.
Altman D, Mellgren A, Blomgren B, López A, Zetterström J, Nordenstam J, et al. Clinical and histological safety assessment of rectocele repair using collagen mesh. Acta Obstet Gynecol Scand. 2004 Oct; 83(10): 995–1000.
 
14.
Altman D, Zetterström J, López A, Anzén B, Falconer C, Hjern F, et al. Functional and anatomic outcome after transvaginal rectocele repair using collagen mesh: a prospective study. Dis Colon Rectum. 2005 Jun; 48(6): 1233–1241.
 
15.
Altman D, Zetterström J, Mellgren A, Gustafsson C, Anzén B, López A. A three-year prospective assessment of rectocele repair using porcine xenograft. Obstet Gynecol. 2006 Jan; 107(1): 59–65.
 
16.
Taylor GB, Moore RD, Miklos JR, Mattox TF. Posterior repair with perforated porcine dermal graft. Int Braz J Urol. 2008 Jan-Feb; 34(1): 84–8.
 
17.
Dahlgren E, Kjølhede P; RPOP-PELVICOL Study Group. Long-term outcome of porcine skin graft in surgical treatment of recurrent pelvic organ prolapse. An open randomized controlled multicenter study. Acta Obstet Gynecol Scand. 2011 Dec; 90(12): 1393–401.
 
18.
Abed H, Rahn DD, Lowenstein L, Balk EM, Clemons JL, Rogers RG. Incidence and management of graft erosion, wound granulation, and dyspareunia following vaginal prolapse repair with graft materials: a systematic review. Int Urogynecol J. 2011; 22: 789–798.
 
19.
Maher C, Feiner B, Baessler K, Adams EJ, Hagen S, Glazener CM. Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev. 2010 Apr 14; (4): CD004014.
 
20.
Sung VW, Radin CR, Raker CA, LaSala CA, Myers DL. Porcine subintestinal submucosal graft augmentation for rectocele repair. Obstet Gyneco. 2012 Jan; 119(1): 125–133.
 
21.
U.S. Food and Drug Administration Web Page [5.03.2014], data issued: 13.07.2011: http://www.fda.gov/MedicalDevi....
 
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