Proving the Efficacy of Autologous Fat Grafting in the Treatment of Rectocele: A Retrospective Study

Proving the Efficacy of Autologous Fat Grafting in the Treatment of Rectocele: A Retrospective Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Method Article Proving the Efficacy of Autologous Fat Grafting in the Treatment of Rectocele: A Retrospective Study Ozgur Dandin, Kamil Ozturk, Veli Vural, Hasan Calis, Mehmet Zafer Sabuncuoglu, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5644289/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Rectocele, a prevalent condition linked with pelvic organ prolapse, affects many women postpartum, leading to symptoms like constipation, straining during bowel movements, and vaginal pressure, significantly impairing quality of life. Traditional surgical procedures for rectocele repair often lead to complications and symptom recurrence. Recently, autologous fat grafting (AFG) has emerged as a minimally invasive alternative. This retrospective study evaluates the efficacy and safety of AFG, using a stem cell-enriched approach for rectocele treatment. Material and Methods Conducted at Akdeniz University Faculty of Medicine, this study included female patients who underwent AFG for rectocele from January 2023 to January 2024. Inclusion criteria were patients diagnosed with rectocele, aged 18 or older, with a follow-up period of at least 6 months post-procedure. Data were collected on patient demographics, clinical characteristics, pre- and post-procedural symptoms, procedural details, and follow-up outcomes. Statistical analysis compared pre- and post-procedural variables using appropriate tests. Results The study included 65 patients, with a mean (± SD) age of 51,2 (± 12,41) years. Pre-procedural symptoms included rectal pain, constipation, and dyspareunia. Post-procedural outcomes demonstrated significant improvements in these symptoms, with a mean (± SD) follow-up period of 12,13 (± 4,29) months. The majority of patients reported symptom relief, particularly from rectal pain and constipation. Complications were minimal, with 25% of patients experiencing mild skin ecchymosis that resolved with treatment. Obstructive defecation, Quality of life, and constipation assessments showed significant improvements, with patients reporting higher satisfaction and improved functional outcomes. Conclusion AFG shows promise as an effective minimally invasive treatment for rectocele. It offers significant symptom relief and improved quality of life with minimal complications. The results suggest that AFG could be a valuable alternative to traditional surgical methods. Rectocele Autologous Fat Grafting Efficacy Retrospective Study Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction Rectocele is a common condition related to pelvic organ prolapse, particularly prevalent in women postpartum[ 1 ]. It occurs due to the weakening or damage of the rectovaginal septum, leading to the bulge of the rectum into the vaginal canal [ 2 ]. This condition can result in symptoms such as constipation, straining during bowel movements, and a sensation of vaginal pressure, significantly impacting patients' quality of life[ 1 ]. The management of rectocele varies depending on the severity of symptoms, patient age, comorbidities, and preferences[ 3 ]. Traditional surgical procedures are used for rectocele repair, including posterior colporrhaphy, transvaginal mesh repair, and rectopexy [ 4 ]. However, it is known that surgical procedures may be inadequate in some patients, lead to serious complications, and cause recurrent symptoms. Despite the numerous surgical techniques available for rectocele treatment, no single method has proven to be superior overall due to the diverse complications and varying recurrence rates associated with each approach. In recent years, there has been an increasing utilization of minimally invasive procedures in rectocele treatment. Injection sclerotherapy is a cost-effective, minimally invasive procedure infrequently applied to rectocele treatment[ 5 – 7 ]. Among these, autologous fat grafting (AFG) has garnered attention [ 8 ]. In this method, the patient's adipose tissue is harvested and injected into the rectocele area. However, existing studies in the literature have suggested that the graft contains adipocytes and potential stem cells, which could enhance the efficacy of the treatment[ 9 ]. This study examines an innovative approach to AFG in rectocele treatment. The fat graft undergoes a special process, being filtered to obtain a stromal vascular fraction (SVF) enriched with stem cells. The first applications of this unique approach in the literature have been conducted. This research aims to analyze the clinical feasibility of a new treatment approach and its impact on patient outcomes. The findings obtained could contribute to our understanding of the role of minimally invasive procedures in rectocele treatment and provide better treatment options for patients. Method Study Design: This is a retrospective clinical investigation performed at the General Surgery Department at Akdeniz University. Akdeniz University Clinical Research Ethics Committee approved this research with the decision dated (date: 07.05.2024) and numbered (no: 264). We aimed to analyze the effectiveness and reliability of AFG in the treatment of rectocele. Participants A total of 65 female patients were involved in this investigation with a symptomatic rectocele, ≥ 2 cm on defecography who underwent AFG, aged 18 years or older, and having completed a follow-up period of at least 6 months post-procedure at our clinic between January 2023 and January 2024. Exclusion criteria encompass patients who did not complete the designated follow-up period, underwent simultaneous procedures for other anorectal conditions such as hemorrhoids, anal fissures, fistulas, experienced data loss or incompleteness, or declined voluntary participation. Preparation of AFG AFG was prepared using a standardized technique (harvesting adipose tissue, tissue processing, and centrifugation) described by Coleman SR[ 10 ]. Additionally following procedures were performed to obtain SVF: Filtration and Emulsification The centrifuged adipose tissue was then processed using a specialized filtration system to obtain a purified fat graft enriched with SVF. The filtration process helps remove excess fluids, blood products, and non-viable cells, resulting in a concentrated and homogeneous fat graft. Subsequently, emulsification was performed by transferring the processed fat graft between two syringes connected by a transducer with an integrated filter. This emulsification step helps ensure uniform distribution of adipose tissue particles and facilitates ease of injection during the grafting procedure. Injection The final AFG product was obtained in a syringe ready for injection. The AFG was then injected into the predetermined site within the rectocele area using a fine-gauge needle under direct visualization. Care was taken to distribute the fat graft evenly and achieve optimal tissue augmentation and support. Following the procedure performed under local anesthesia, no antibiotics were prescribed to the patients, and they were discharged from the hospital after a one-hour observation period. By following this standardized protocol, we aimed to obtain a high-quality AFG suitable for rectocele repair while minimizing procedural risks and optimizing patient outcomes. This methodological approach ensures consistency and reproducibility in AFG preparation, thereby enhancing the safety and efficacy of the treatment. Data Collection Data collection involves a retrospective review of medical records, including patient demographics (age, BMI, obstetric history, previous surgical procedures, concomitant pelvic diseases, and comorbidities), surgical characteristics, pre-postoperative symptoms (painful evacuation effort, incomplete evacuation, need for digital assistance, vaginal splinting, difficulty in defecation, use of laxatives or enemas, straining at defecation, hard stools, constipation, abdominal bloating, abdominal pain, urinary symptoms (incontinence), vaginal symptoms (dyspareunia, vaginal bulge), fecal incontinence, ınfrequent bowel movements, rectal pain, rectal bleeding, anal swelling). Additionally, various questionnaires, scoring systems, and physical examinations were used to assess the success of the procedure pre-and post-operatively, involving the Patient Assessment of Constipation–Quality of Life (PAC-QOL)[ 11 ], Obstructed Defecation Syndrome (ODS) Score Questionnaire [ 12 ], Constipation Score[ 13 ], and stage of rectocele (Stage 0 (no rectocele), Stage 1 (mild rectocele), Stage 2 (moderate rectocele), or Stage 3 (severe rectocele))[ 14 ]. Satisfaction rates were also calculated for all patients. Statistical Analysis Descriptive statistics were applied to summarize patient demographics and clinical features. Comparative analysis between pre-procedural and post-procedural variables will be conducted using appropriate statistical tests such as paired-sample t-test for continuous data and the McNemar test for categorical data. Statistical significance will be set at p < 0.05. Ethical Considerations: This study was performed following the guidelines set forth in the Declaration of Helsinki. Ethical approval was granted by the Institutional Review Board at Akdeniz University Faculty of Medicine. All participants provided informed consent before being enrolled in the study. Termination Criteria The study will be concluded on the patients who have completed a follow-up period of 6 months post-procedure. This detailed method section outlines the study design, participant selection criteria, data collection process, statistical analysis plan, ethical considerations, and termination criteria for the research project evaluating the effectiveness of AFG in rectocele treatment. Results The findings of the retrospective investigation evaluating the effectiveness of AFG in the treatment of rectocele are presented below: Demographic and clinical characteristics of the patients are demonstrated in Table 1 . The average age of the patients was 51.2 years, with a standard deviation (SD) of 12.41. The mean Body Mass Index (BMI) was 27.92, with an SD of 4.91. In terms of obstetric history, the mean number of parity was 2.52 (SD = 1.34), the mean number of vaginal deliveries was 1.66 (SD = 1.71), and the average number of traumatic deliveries was 0.55 (SD = 0.70). Regarding the surgical procedures, 26% of the patients underwent a hysterectomy, 11% had pelvic floor surgery, 35% had anal surgery, and 11% underwent rectocele repair with mesh (n = 7). For concomitant pelvic diseases, 14% of the patients had vaginal prolapse, 3% had cystocele, 46% had anal fissure, 58% had hemorrhoids, 22% had mucosal rectal prolapse, and 1.5% had anal fistula. Data for rectal intussusception, pelvic decensus, enterocele, and anismus were recorded as 33,84%, 4,6%, 3,1%, and 0%, respectively. In terms of comorbidities, the percent of the patients who had hypertension and diabetes mellitus were 29.23% and 15.38%, respectively. Among all patients, 15.38% had asthma, 7.70% had cardiovascular diseases (including arrhythmia, bypass, cardiac stent, and palpitations), 10.77% had thyroid disorders, and 21.54% had other diseases such as Familial Mediterranean Fever (FMF), cholesterol issues, vertigo, epilepsy, reflux, neurogenic bladder, etc. Table 1 Demographic characteristics of patients Age (mean ± SD) 51,2 ± 12,41 BMI(mean ± SD) 27,92 ± 4,91 Obstetric history(mean ± SD) * Number of parity 2,52 ± 1,34 * Number of vaginal deliveries 1,66 ± 1,71 * Traumatic deliveries 0,55 ± 0,70 Surgical procedures(%) * Hysterectomy 26 * Pelvic floor surgery 11 * Anal surgery 35 * Rectocele repair with mesh (n = 7) 11 Concomitant pelvic diseases(%) *Vaginal prolapse 14 *Cystocele 3 *Anal fissura 46 *Hemorrhoid 58 *Mucosal rectal prolapse 22 *Anal fistula 1,5 *Rectal intussusception 33,84 *Pelvic decensus 4,6 *Enterocele 3,1 *Anismus 0 Comorbidities *Hypertension 29,23 *Diabetes Mellitus 15,38 *Asthma 15,38 *Cardiovascular Diseases (arrhythmia, bypass, cardiac stent, palpitations) 7,70 *Thyroid disorders 10,77 *Other Diseases (FMF, cholesterol, vertigo, epilepsy, reflux, neurogenic, bladder, etc.) 21,54 Pre-procedural symptoms are listed in Table 2 . Before surgery, patients exhibited a range of symptoms with varying frequencies. The most common symptom was difficulty in defecation (95.4%), followed closely by straining at defecation (93.8%). Constipation was another prevalent issue (90.8%). Hard stools and abdominal bloating were noted in 83.1 and 81.5%, respectively. Others are listed in Table 2 . Table 2 Main preoperative and postoperative symptoms and findings Preoperative (%) Postoperative (%) Significance p Painful evacuation effort 76,9 26,2 < 0.05 Incomplete evacuation 76,9 21,5 < 0.05 Need of digital assistance 50,8 21,5 0,05 Difficulty in defecation 95,4 27,7 < 0.05 Use of laxatives or enemas 55,4 12,3 < 0.05 Straining at defecation 93,8 20 < 0.05 Hard stools 83,1 13,8 < 0.05 Constipation 90,8 20 < 0.05 Abdominal bloating 81,5 27,7 < 0.05 Abdominal pain 67,7 18,5 < 0.05 Urinary symptoms (incontinence) 38,5 16,9 < 0.05 Vaginal symptoms *Dyspareunia 58,5 27,7 0,05 Fecal incontinence 10,8 4,6 > 0,05 Infrequent bowel movements 38,2 10,8 < 0.05 Rectal pain 75,4 16,9 < 0.05 Rectal bleeding 61,5 9,2 < 0.05 Anal swelling 44,6 7,2 < 0.05 Surgical characteristics and post-procedural outcomes: Surgical characteristics of the patients are listed in Table 3 . The average operation time and hospital stay were 15 minutes and 2 hours, respectively. The follow-up period (mean ± SD) averaged 12.13 ± 4.29 (ranged 7–19) months. Complications associated with AFG were minimal, with 35% of patients experiencing minimal skin ecchymosis resulting from liposuction. The symptoms resolved with treatment using mucopolysaccharide polysulfate (chondroitin polysulfate) cream. These complications were managed conservatively without the need for additional intervention in most cases. Additionally, 18% of the patients (n = 12) required a second procedure, and only 31% of the patients needed postoperative analgesics for 2 days. Table 3 Surgical characteristics of the patients Operation time (minutes) 15 Hospital stay (hours) 2 Peroperative complication None Follow up time (mean ± SD/range) 12,13 ± 4,29/range: 7–19 months) Postoperative complications (Ecchymosis)(%) 65 Need for a second procedure (%) (n = 12) 18 Postoperative analgesic use (%) 31 Post-procedural outcomes listed in Tables 2 and 4 , and also were assessed through a combination of physical examination, patient-reported symptoms, and 3 scoring systems. The comparison between preoperative and postoperative symptoms and findings shows a significant reduction in most of the symptoms following surgery (Fig. 1). Table 4 Evaluation of the surgical procedure using various scoring system Preoperative (mean ± SD) Postoperative (mean ± SD) Significance p Patient Assessment of Constipation–Quality of Life (PAC-QOL) 99,87 ± 9,86 46,58 ± 21,51 < 0,05 Obstructed Defecation Syndrome Score Questionnaire (Altomare et al, 2008) 17,91 ± 6,67 7,93 ± 5,61 < 0,05 Constipation Score (Agachan F,1996) 9,69 ± 4,62 4,72 ± 3,69 < 0,05 The results demonstrate a significant improvement in patients’ stage of rectocele following the procedure (Fig. 2). Before the intervention, 41.5% of patients were classified as Stage 3, 38.5% were in Stage 2, and 20% were in Stage 1, with no patients in Stage 0. After the procedure, there was a substantial shift, with 49.2% of patients moving to Stage 1 and 26.2% achieving Stage 0. Meanwhile, 20% remained in Stage 2, and only 4.6% remained in Stage 3. These changes highlight the effectiveness of the treatment in reducing the severity of symptoms and improving the overall condition of the patients. The surgical procedure was evaluated using several scoring systems demonstrated in Table 4 and the results showed significant improvements postoperatively. The PAC-QOL score decreased from a preoperative mean of 99.87 ± 9.86 to a postoperative mean of 46.58 ± 21.51, with a significance level of p < 0.05. This presents a notable improvement in the patient's postoperative life quality (Fig. 3a). The ODS Score Questionnaire also showed a significant reduction, with the preoperative score decreasing from 17.91 ± 6.67 to a postoperative score of 7.93 ± 5.61 (p < 0.05). This suggests a substantial decrease in symptoms related to obstructed defecation following surgery (Fig. 3b). Similarly, the Constipation Score (Agachan F, 1996) improved significantly, with the preoperative mean score of 9.69 ± 4.62 dropping to 4.72 ± 3.69 postoperatively (p < 0.05), indicating a reduction in constipation severity after the surgical intervention (Fig. 3c). Overall, these scoring systems demonstrate that the surgical procedure led to significant improvements in patient outcomes across various measures (Fig. 3). A survey of patient satisfaction following the operation revealed varying levels of contentment (Fig. 4). Among the patients, 11% (7 patients) rated their satisfaction as poor, while 15% (10 patients) considered it sufficient. A total of 18% (12 patients) described their satisfaction as good. The majority, 56% (36 patients), reported an excellent level of satisfaction with the outcome of their surgery. These results indicate a generally high rate of satisfaction among the patients (Fig. 4a). Twelve patients (18%) underwent a second fat transfer due to poor satisfaction after the first procedure. The satisfaction rates for patients who underwent a second procedure are as follows, listed from highest to lowest. A majority of 50% (6 patients) reported an excellent level of satisfaction, while 25% (3 patients) described their satisfaction as good. Additionally, 17% (2 patients) considered their satisfaction sufficient, and 8% (1 patient) rated their satisfaction as poor (Fig. 4b). Also, these patients were evaluated using various scoring systems, showing significant improvements postoperatively (Table 5 ). PAC-QOL score decreased from a preoperative mean of 101.92 ± 7.89 to a postoperative mean of 46.33 ± 22.62, with a significance level of p < 0.05. Similarly, the ODS Score Questionnaire showed a significant reduction, with the preoperative score decreasing from 17.66 ± 5.58 to a postoperative score of 7.83 ± 4.32 (p < 0.05). The Constipation Score also improved significantly, with the preoperative mean score of 9 ± 3.54 dropping to 4.41 ± 2.46 postoperatively (p < 0.05). These findings indicate that the second repeated intervention led to substantial improvements in patient outcomes across these measures. Table 5 Evaluation of the surgical procedure using various scoring system for second procedure Preoperative (mean ± SD) Postoperative (mean ± SD) Significance p Patient Assessment of Constipation–Quality of Life (PAC-QOL) 101,92 ± 7,89 46,33 ± 22,62 < 0,05 Obstructed Defecation Syndrome Score Questionnaire (Altomare et al, 2008) 17,66 ± 5,58 7,83 ± 4,32 < 0,05 Constipation Score (Agachan F,1996) 9 ± 3,54 4,41 ± 2,46 < 0,05 The outcomes for patients who had rectocele repair with mesh (n = 7; 11%) and later received autologous fat transfer due to low satisfaction were in line with the overall results. Following the procedure, the patient satisfaction results were as follows: 43% of patients (3 patients) rated their satisfaction as sufficient, and another 43% (3 patients) described it as good. Meanwhile, 14% (1 patient) reported excellent satisfaction. Notably, no patients rated their satisfaction as poor (Fig. 4c). The evaluation of these patients was conducted using various scoring systems, showing significant improvements postoperatively (Table 6 ). PAC-QOL score decreased from a preoperative mean of 101 ± 8.99 to a postoperative mean of 48.57 ± 16.18, with a significance level of p < 0.05. The ODS Score Questionnaire also showed a significant reduction, with the preoperative score decreasing from 18.71 ± 5.1 to a postoperative score of 6.86 ± 2.61 (p < 0.05). Additionally, the Constipation Score (Agachan F, 1996) improved significantly, with the preoperative mean score of 9.43 ± 4.86 dropping to 3.57 ± 1.40 postoperatively (p < 0.05). Table 6 Evaluation of the fat transfer due to insufficent mesh repair using various scoring system Preoperative (mean ± SD) Postoperative (mean ± SD) Significance p Patient Assessment of Constipation–Quality of Life (PAC-QOL) 101 ± 8,99 48,57 ± 16,18 < 0,05 Obstructed Defecation Syndrome Score Questionnaire (Altomare et al, 2008) 18,71 ± 5,1 6,86 ± 2,61 < 0,05 Constipation Score (Agachan F,1996) 9,43 ± 4,86 3,57 ± 1,40 < 0,05 Discussion Various surgical techniques have been proposed for repair of the rectocele. However, there is inadequate proof to determine which technic is the most effective or whether any specific technique is superior in certain conditions [ 15 , 16 ]. The standard approach for rectocele repair is transvaginal surgery, often carried out by gynecologists in conjunction with other techniques like levatorplasty, hysterectomy, and cystocele repair [ 15 ]. Many researchers have documented positive anatomical outcomes after transvaginal repair [ 17 – 19 ]. Despite this, major issues with vaginal methods include sexual dysfunction and dyspareunia. Kahn and Stanton[ 18 ] noted postoperative dyspareunia rates varying from 12–25% with a rise in the preoperative sexual dysfunction rate from 18–27% after transvaginal repair [ 15 , 17 ]. Additionally, the recurrence rate of rectocele varied from 5.7–7% following transvaginal procedures [ 17 , 19 ]. The transabdominal method is significantly advised for individuals with high defects in the rectovaginal fascia, manifesting as enterocele and rectocele. The laparoscopic technique might be favored over the transvaginal approach for managing complicated cases of extensive rectocele [ 20 ]. The transperineal technique is rarely employed and is typically reserved for rectocele cases with incontinence caused by a defect in the anal sphincter [ 15 ], as it provides access to the levator ani and external anal sphincter, simultaneously. The transanal method enables addressing coexisting anorectal issues like intussusception and hemorrhoids [ 17 , 21 ]. As a result, this approach is usually used in patients who have obstructed defecation or other anorectal issues associated with rectocele. The main contraindications for the transanal technique are puborectalis dyssynergia, enterocele and high rectoceles [ 15 ]. Longo proposed a different method for treating obstructed defecation caused by intussusception and rectocele, called stapled transanal rectal resection (STARR) [ 15 ]. While the STARR procedure provides significant relief from rectal symptoms by correcting rectocele and intussusception, it is associated with certain complications. Postoperative bleeding rates with the STARR technique ranged from 3.3–26.6%, fecal urgency occurred in 1.1–34% of patients, and flatus incontinence was observed in 6–26.7% of cases [ 17 , 19 , 22 ]. The rate of recurrence associated with STARR remains under 40% [ 17 , 19 ]. Initially introduced as a treatment for severe rectal mucosal prolapse, the Delorme procedure involves transanal sleeve mucosectomy. Today, the Delorme technique is deemed effective for managing obstructed defecation caused by rectal intussusception and rectocele [ 15 ]. The Delorme method can be performed with regional anesthesia and carries a low risk of postoperative complications [ 15 , 21 ]. Injection sclerotherapy, a less invasive and affordable technique for managing rectal prolapse and hemorrhoids, is infrequently used for rectocele repair [ 6 , 23 ]. According to Tsiaoussis et al., sclerotherapy with a 5% phenol-based solution in arachis oil targeting symptomatic mucosal prolapse linked to rectocele in 78% of cases achieved a 51% success rate [ 7 ]. Nonetheless, notable complications associated with sclerotherapy were identified. Misplaced injections during sclerotherapy might cause mucosal ulceration or necrosis, fever, or prostatitis[ 24 ]. Our research demonstrates that AFG is successful in alleviating and improving patient outcomes. A significant decrease was observed in key symptoms such as difficulty in defecation, incomplete evacuation, straining, constipation, abdominal pain, and rectal pain. Postoperative complications were minimal, and patient satisfaction was generally high, with most patients reporting excellent or good outcomes. A significant shift in rectocele stages was observed, with most patients moving to lower stages postoperatively, alongside high satisfaction rates reported in the surveys. Importantly, in patients who initially experienced dissatisfaction or suboptimal results from other treatments, the application of AFG showed a notably high satisfaction rate. Even among those who required a second fat transfer, the majority reported a significant improvement after the second procedure, highlighting the procedure's success. Moreover, AFG serves as a valuable complementary option to other treatments, providing an additional avenue for improving patient satisfaction and outcomes in cases where initial approaches may not fully resolve symptoms. In patients who previously underwent mesh-assisted rectocele repair but did not experience complete resolution of their symptoms, we applied AFG. Among a total of 7 patients, 6 reported a satisfaction level of good or higher following the AFG procedure. These findings suggest that AFG is not only an effective treatment for rectocele but also offers a repeatable and customizable solution for patients who do not respond to other interventions. This reinforces its role as a flexible, patient-centric treatment modality with promising long-term benefits. Although defecography is known to be the most reliable examination for the diagnosis of rectocele[ 25 ], a rectocele identified via defecography does not always correspond to one detected through physical examination in patients presenting with defecatory symptoms[ 26 ]. The majority of studies have been unable to establish a link between defecography metrics (postvoid residual, perineal descent, or rectocele size, etc.) and successful clinical outcomes after rectocele repairs [ 25 , 27 ]. In a group of symptomatic women, Shannon L. Wallace and colleagues[ 26 ] found that the detection of a rectocele via defecography does not inherently confirm its presence during a physical examination. Their research highlighted that the diagnosis and surgical management of rectocele should primarily rely on clinical findings from physical examination and patient-reported symptoms. Therefore, in our study, we prioritized physical examination to highlight the effectiveness of this innovative approach in the treatment of rectocele. The application of AFG in the vulvovaginal area has been shown to help manage sexual function issues in women, improve aesthetics, restore tissue volume, relieve lubrication-related dyspareunia, and reduce scar tissue pain[ 28 ]. The AFG technique in the treatment of rectocele was first described and applied by Zetlitz and colleagues in 2013[ 8 ]. They use Coleman’s technique for obtaining fat grafts [ 29 ]. In Coleman's technique, the harvested adipose tissue undergoes a centrifugation process. The fraction containing blood and its elements is discarded. In our technique, to obtain stem cell-enriched adipose tissue (SVF), an additional step of filtration through different-sized filters is performed. The resulting product is injected into the rectovaginal area. The posterior vaginal wall defect was successfully repaired using this minimally invasive technique. Therefore, this application in the treatment of rectocele has no known equivalent in the literature. Additionally, fat grafting offers a minimally invasive option for these patients. AFG is commonly employed in reconstructive and aesthetic procedures, such as improving skin texture, reducing scar tissue, addressing soft-tissue deficits, and augmenting body parts[ 30 , 31 ], as it is easily accessible, compatible with the body, natural in appearance, and does not provoke immune reactions [ 32 ]. Indeed, cell-based approaches enhance the viability of fat grafts by supplementing them with additional ADSCs [ 33 ]. The SVF is composed of multipotent constituents, including ADSCs, fibroblasts, endothelial cells, immune cells, and pericytes, which can be efficiently harvested from adipose tissue [ 34 ]. Due to its regenerative abilities, such as growth factor secretion and stimulation of dermal angiogenesis, SVF has been utilized to manage conditions related to scarring [ 35 ]. Koh et al.[ 36 ] proposed that co-implanting SVF to enhance vascularization could improve the microenvironment and increase graft survival. Survival rates for AFG range from 24–51.4%, whereas fat grafts enriched with freshly isolated SVF exhibit improved survival rates (63–90.4%) compared to conventional lipofilling over 12 to 19 months of follow-up [ 37 – 39 ]. By using this method, we aimed not only to create a barrier in the rectovaginal space by filling it, which might be temporary but also to utilize the regenerative and other beneficial properties of mesenchymal stem cells released by filtering the fat tissue. The favorable outcomes observed in our study underscore the potential of AFG as a minimally invasive alternative to traditional surgical approaches for rectocele repair. AFG offers several advantages, including its autologous nature, minimal donor site morbidity, and potential for long-term tissue integration. Moreover, AFG may be particularly beneficial for patients who are not candidates for or prefer to avoid traditional surgical interventions. However, further research is needed to delineate patient selection criteria, optimal procedural techniques, and long-term outcomes of AFG in rectocele management. Various constraints should be taken into account when interpreting the outcomes of this research. The retrospective nature of the study naturally introduces selection bias and hinders establishing causal relationships. The limited sample size and single-institution framework could restrict the generalizability of our conclusions. The lack of a control group makes it impossible to directly compare outcomes with alternative therapeutic options. Prospective research involving broader, multicenter populations and longer observation periods is necessary to address these issues and yield more conclusive data. Future research endeavors should focus on addressing the limitations of our study and further elucidating the role of AFG in rectocele treatment. Prospective comparative studies comparing AFG with conventional surgical techniques, as well as other minimally invasive approaches, are warranted to establish the relative efficacy and safety profiles. Long-term follow-up researches are needed to evaluate the durability of the outcomes and the incidence of recurrence over time. Moreover, investigations into the underlying mechanisms of action of AFG in tissue regeneration and remodeling are essential for optimizing procedural techniques and enhancing patient outcomes. We believe that the treatment of rectocele with AFG should be considered primarily as a cost-effective, repeatable, and complication-free option compared to other methods that involve surgical and non-surgical complications, significant recurrence rates, longer operation and hospitalization times, and higher costs. To summarize, our findings suggest preliminary support for the use of AFG as a treatment for rectocele. Although encouraging, additional investigations are necessary to confirm and expand upon these results, refine procedural protocols, and expand our understanding of AFG's therapeutic mechanisms. Ultimately, a multidisciplinary approach integrating clinical expertise, patient preferences, and scientific evidence will be crucial in optimizing rectocele management and improving patient outcomes. Declarations Financial Disclosure: None reported. Funding Declaration: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Author Contribution Concept - OD, KO; Design - HC; Supervision - OD,MZS,VV; Proofing - OD,KO; Materials - OD,HC; Data and/or Processing - OD, KO,IZ; Analysis and/or Interpretation - OD,KO,MZS; Literature Search - OD, VV; Writing - OD,KO; Critical Reviews - OD,VV; Other - OD References Mustain WC (2016) Functional Disorders: Rectocele. Clinics in Colon and Rectal Surgery 30:63–75. https://doi.org/10.1055/s-0036-1593425 Beck DE, Allen NL (2010) Rectocele. Clin Colon Rectal Surg 23:90–98. https://doi.org/10.1055/s-0030-1254295 Gallo G, Trompetto M (2019) Complete rectal prolapse: still a lot of work to do. Tech Coloproctol 23:287–288. https://doi.org/10.1007/s10151-019-01961-8 Cundiff GW, Fenner D (2004) Evaluation and treatment of women with rectocele: focus on associated defecatory and sexual dysfunction. Obstet Gynecol 104:1403–1421. https://doi.org/10.1097/01.AOG.0000147598.50638.15 Abe T, Kunimoto M, Hachiro Y, Ebisawa Y (2016) Injection sclerotherapy using aluminum potassium sulfate and tannic acid in the treatment of symptomatic rectocele: A prospective case series. International Journal of Surgery 30:94–98. https://doi.org/10.1016/j.ijsu.2016.04.039 Abe T, Hachiro Y, Kunimoto M (2014) Combined aluminum potassium sulfate and tannic acid sclerosing therapy and anal encirclement using an elastic artificial ligament for rectal prolapse. Dis Colon Rectum 57:653–657. https://doi.org/10.1097/DCR.0000000000000087 Tsiaoussis J, Chrysos E, Glynos M, et al (1998) Pathophysiology and treatment of anterior rectal mucosal prolapse syndrome. Br J Surg 85:1699–1702. https://doi.org/10.1046/j.1365-2168.1998.00914.x Zetlitz E, Manook M, MacLeod A, Hamilton S (2013) A new reconstructive technique for posterior vaginal wall defects, a case report. J Sex Med 10:2579–2581. https://doi.org/10.1111/jsm.12056 Sowa Y, Mazda O, Tsuge I, et al (2022) Roles of adipose-derived stem cells in cell-based therapy: current status and future scope—a narrative review. Digestive Medicine Research 5:. https://doi.org/10.21037/dmr-22-32 Coleman SR (2006) Structural fat grafting: more than a permanent filler. Plast Reconstr Surg 118:108S-120S. https://doi.org/10.1097/01.prs.0000234610.81672.e7 Frank L, Kleinman L, Farup C, et al (1999) Psychometric validation of a constipation symptom assessment questionnaire. Scand J Gastroenterol 34:870–877. https://doi.org/10.1080/003655299750025327 Altomare DF, Spazzafumo L, Rinaldi M, et al (2008) Set-up and statistical validation of a new scoring system for obstructed defecation syndrome. Colorectal Dis 10:84–88. https://doi.org/10.1111/j.1463-1318.2007.01262.x Agachan F, Chen T, Pfeifer J, et al (1996) A constipation scoring system to simplify evaluation and management of constipated patients. Dis Colon Rectum 39:681–685. https://doi.org/10.1007/BF02056950 Wallace SL, Torosis M, Rogo-Gupta L (2021) Does Rectocele on Defecography Equate to Rectocele on Physical Examination in Patients With Defecatory Symptoms? Female Pelvic Med Reconstr Surg 27:18–22. https://doi.org/10.1097/SPV.0000000000000719 Zbar AP, Lienemann A, Fritsch H, et al (2003) Rectocele: pathogenesis and surgical management. Int J Colorectal Dis 18:369–384. https://doi.org/10.1007/s00384-003-0478-z Janssen LW, van Dijke CF (1994) Selection criteria for anterior rectal wall repair in symptomatic rectocele and anterior rectal wall prolapse. Dis Colon Rectum 37:1100–1107. https://doi.org/10.1007/BF02049811 Leanza V, Intagliata E, Leanza G, et al (2013) Surgical repair of rectocele. Comparison of transvaginal and transanal approach and personal technique. G Chir 34:332–336 Kahn MA, Stanton SL (1997) Posterior colporrhaphy: its effects on bowel and sexual function. Br J Obstet Gynaecol 104:82–86. https://doi.org/10.1111/j.1471-0528.1997.tb10654.x Nieminen K, Hiltunen K-M, Laitinen J, et al (2004) Transanal or vaginal approach to rectocele repair: a prospective, randomized pilot study. Dis Colon Rectum 47:1636–1642. https://doi.org/10.1007/s10350-004-0656-2 Vizeteu R, Iordache N, Andrei D (2015) Laparoscopic Mesh Sacropexy for Voluminous Rectocele. Chirurgia (Bucur) 110:268–274 Abbas SM, Bissett IP, Neill ME, et al (2005) Long-term results of the anterior Délorme’s operation in the management of symptomatic rectocele. Dis Colon Rectum 48:317–322. https://doi.org/10.1007/s10350-004-0819-1 Zhang B, Ding J-H, Yin S-H, et al (2010) Stapled transanal rectal resection for obstructed defecation syndrome associated with rectocele and rectal intussusception. World J Gastroenterol 16:2542–2548. https://doi.org/10.3748/wjg.v16.i20.2542 Hachiro Y, Kunimoto M, Abe T, et al (2011) Aluminum potassium sulfate and tannic acid (ALTA) injection as the mainstay of treatment for internal hemorrhoids. Surg Today 41:806–809. https://doi.org/10.1007/s00595-010-4386-x Takano M, Iwadare J, Ohba H, et al (2006) Sclerosing therapy of internal hemorrhoids with a novel sclerosing agent. Comparison with ligation and excision. Int J Colorectal Dis 21:44–51. https://doi.org/10.1007/s00384-005-0771-0 van Dam JH, Ginai AZ, Gosselink MJ, et al (1997) Role of defecography in predicting clinical outcome of rectocele repair. Dis Colon Rectum 40:201–207. https://doi.org/10.1007/BF02054989 Wallace SL, Torosis M, Rogo-Gupta L (2021) Does Rectocele on Defecography Equate to Rectocele on Physical Examination in Patients With Defecatory Symptoms? Female Pelvic Med Reconstr Surg 27:18–22. https://doi.org/10.1097/SPV.0000000000000719 Stojkovic SG, Balfour L, Burke D, et al (2003) Does the need to self-digitate or the presence of a large or nonemptying rectocoele on proctography influence the outcome of transanal rectocele repair? Colorectal Dis 5:169–172. https://doi.org/10.1046/j.1463-1318.2003.00427.x Lai Y-W, Wu S-H, Chou P-R, et al (2023) Autologous Fat Grafting in Female Genital Area Improves Sexual Function by Increasing Collagenesis, Angiogenesis, and Estrogen Receptors. Aesthet Surg J 43:872–884. https://doi.org/10.1093/asj/sjad040 Coleman SR (2004) Structural fat grafting. St Louis, MO Oranges CM, Striebel J, Tremp M, et al (2018) The Impact of Recipient Site External Expansion in Fat Grafting Surgical Outcomes. Plast Reconstr Surg Glob Open 6:e1649. https://doi.org/10.1097/GOX.0000000000001649 Strong AL, Cederna PS, Rubin JP, et al (2015) The Current State of Fat Grafting: A Review of Harvesting, Processing, and Injection Techniques. Plast Reconstr Surg 136:897–912. https://doi.org/10.1097/PRS.0000000000001590 Wang G-H-E, Zhao J-F, Xue H-Y, Li D (2019) Facial aesthetic fat graft retention rates after filtration, centrifugation, or sedimentation processing techniques measured using three-dimensional surface imaging devices. Chin Med J (Engl) 132:69–77. https://doi.org/10.1097/CM9.0000000000000016 Luan A, Duscher D, Whittam AJ, et al (2016) Cell-Assisted Lipotransfer Improves Volume Retention in Irradiated Recipient Sites and Rescues Radiation-Induced Skin Changes. Stem Cells 34:668–673. https://doi.org/10.1002/stem.2256 Sheu J-J, Lee MS, Wallace CG, et al (2019) Therapeutic effects of adipose derived fresh stromal vascular fraction-containing stem cells versus cultured adipose derived mesenchymal stem cells on rescuing heart function in rat after acute myocardial infarction. Am J Transl Res 11:67–86 Lee JW, Park SH, Lee SJ, et al (2018) Clinical Impact of Highly Condensed Stromal Vascular Fraction Injection in Surgical Management of Depressed and Contracted Scars. Aesthetic Plast Surg 42:1689–1698. https://doi.org/10.1007/s00266-018-1216-9 Koh YJ, Koh BI, Kim H, et al (2011) Stromal vascular fraction from adipose tissue forms profound vascular network through the dynamic reassembly of blood endothelial cells. Arterioscler Thromb Vasc Biol 31:1141–1150. https://doi.org/10.1161/ATVBAHA.110.218206 Gontijo-de-Amorim NF, Charles-de-Sá L, Rigotti G (2017) Mechanical Supplementation With the Stromal Vascular Fraction Yields Improved Volume Retention in Facial Lipotransfer: A 1-Year Comparative Study. Aesthet Surg J 37:975–985. https://doi.org/10.1093/asj/sjx115 Tissiani L a. L, Alonso N (2016) A Prospective and Controlled Clinical Trial on Stromal Vascular Fraction Enriched Fat Grafts in Secondary Breast Reconstruction. Stem Cells Int 2016:2636454. https://doi.org/10.1155/2016/2636454 Gentile P, Orlandi A, Scioli MG, et al (2012) A comparative translational study: the combined use of enhanced stromal vascular fraction and platelet-rich plasma improves fat grafting maintenance in breast reconstruction. Stem Cells Transl Med 1:341–351. https://doi.org/10.5966/sctm.2011-0065 Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5644289","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Method Article","associatedPublications":[],"authors":[{"id":392907176,"identity":"902680ce-fef8-46a4-82c0-117903924c2a","order_by":0,"name":"Ozgur Dandin","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5klEQVRIiWNgGAWjYDCCAwwMEgkQJuMDIMHDR4oWZgOQFjaitECZbGAGQS18x88evPFwh429fETus8qvOXYybAzMDx/dwKNF8kxeskXimTRmwxvpZrdltyUDHcZmbJyDR4vBgRwzicS2w2yGM9LYbktuYwZq4WGTxqvl/BuwFh6QlmLJbfVEaLkBsUVCXiKNjfHjtsOEtUjeeGNskdiWZmDA84xZmnHbcR42ZgJ+4TufY3jzZxswxNrTGD/+3FZtz8/e/PAxPi0IFx4AxiUPiMVMjHIQkG8AppgfxKoeBaNgFIyCEQUA16pD/mX0IckAAAAASUVORK5CYII=","orcid":"","institution":"Akdeniz University","correspondingAuthor":true,"prefix":"","firstName":"Ozgur","middleName":"","lastName":"Dandin","suffix":""},{"id":392907177,"identity":"b233b3c1-8d49-4caf-928d-7c163b9bc63f","order_by":1,"name":"Kamil Ozturk","email":"","orcid":"","institution":"Akdeniz University","correspondingAuthor":false,"prefix":"","firstName":"Kamil","middleName":"","lastName":"Ozturk","suffix":""},{"id":392907178,"identity":"e5beb4a7-6cd9-4117-b011-c35552d4b501","order_by":2,"name":"Veli 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01:01:24","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1051157,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5644289/v1/8b85eed5-98c0-472b-b221-eb9db0db1f3a.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Proving the Efficacy of Autologous Fat Grafting in the Treatment of Rectocele: A Retrospective Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eRectocele is a common condition related to pelvic organ prolapse, particularly prevalent in women postpartum[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. It occurs due to the weakening or damage of the rectovaginal septum, leading to the bulge of the rectum into the vaginal canal [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. This condition can result in symptoms such as constipation, straining during bowel movements, and a sensation of vaginal pressure, significantly impacting patients' quality of life[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe management of rectocele varies depending on the severity of symptoms, patient age, comorbidities, and preferences[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Traditional surgical procedures are used for rectocele repair, including posterior colporrhaphy, transvaginal mesh repair, and rectopexy [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. However, it is known that surgical procedures may be inadequate in some patients, lead to serious complications, and cause recurrent symptoms.\u003c/p\u003e \u003cp\u003eDespite the numerous surgical techniques available for rectocele treatment, no single method has proven to be superior overall due to the diverse complications and varying recurrence rates associated with each approach.\u003c/p\u003e \u003cp\u003eIn recent years, there has been an increasing utilization of minimally invasive procedures in rectocele treatment. Injection sclerotherapy is a cost-effective, minimally invasive procedure infrequently applied to rectocele treatment[\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAmong these, autologous fat grafting (AFG) has garnered attention [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. In this method, the patient's adipose tissue is harvested and injected into the rectocele area. However, existing studies in the literature have suggested that the graft contains adipocytes and potential stem cells, which could enhance the efficacy of the treatment[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study examines an innovative approach to AFG in rectocele treatment. The fat graft undergoes a special process, being filtered to obtain a stromal vascular fraction (SVF) enriched with stem cells. The first applications of this unique approach in the literature have been conducted. This research aims to analyze the clinical feasibility of a new treatment approach and its impact on patient outcomes. The findings obtained could contribute to our understanding of the role of minimally invasive procedures in rectocele treatment and provide better treatment options for patients.\u003c/p\u003e"},{"header":"Method","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design:\u003c/h2\u003e \u003cp\u003eThis is a retrospective clinical investigation performed at the General Surgery Department at Akdeniz University. Akdeniz University Clinical Research Ethics Committee approved this research with the decision dated (date: 07.05.2024) and numbered (no: 264). We aimed to analyze the effectiveness and reliability of AFG in the treatment of rectocele.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eParticipants\u003c/h3\u003e\n\u003cp\u003eA total of 65 female patients were involved in this investigation with a symptomatic rectocele, \u0026ge; 2 cm on defecography who underwent AFG, aged 18 years or older, and having completed a follow-up period of at least 6 months post-procedure at our clinic between January 2023 and January 2024. Exclusion criteria encompass patients who did not complete the designated follow-up period, underwent simultaneous procedures for other anorectal conditions such as hemorrhoids, anal fissures, fistulas, experienced data loss or incompleteness, or declined voluntary participation.\u003c/p\u003e\n\u003ch3\u003ePreparation of AFG\u003c/h3\u003e\n\u003cp\u003eAFG was prepared using a standardized technique (harvesting adipose tissue, tissue processing, and centrifugation) described by Coleman SR[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Additionally following procedures were performed to obtain SVF:\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eFiltration and Emulsification\u003c/strong\u003e \u003cp\u003eThe centrifuged adipose tissue was then processed using a specialized filtration system to obtain a purified fat graft enriched with SVF. The filtration process helps remove excess fluids, blood products, and non-viable cells, resulting in a concentrated and homogeneous fat graft. Subsequently, emulsification was performed by transferring the processed fat graft between two syringes connected by a transducer with an integrated filter. This emulsification step helps ensure uniform distribution of adipose tissue particles and facilitates ease of injection during the grafting procedure.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eInjection\u003c/strong\u003e \u003cp\u003eThe final AFG product was obtained in a syringe ready for injection. The AFG was then injected into the predetermined site within the rectocele area using a fine-gauge needle under direct visualization. Care was taken to distribute the fat graft evenly and achieve optimal tissue augmentation and support.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eFollowing the procedure performed under local anesthesia, no antibiotics were prescribed to the patients, and they were discharged from the hospital after a one-hour observation period.\u003c/p\u003e \u003cp\u003eBy following this standardized protocol, we aimed to obtain a high-quality AFG suitable for rectocele repair while minimizing procedural risks and optimizing patient outcomes. This methodological approach ensures consistency and reproducibility in AFG preparation, thereby enhancing the safety and efficacy of the treatment.\u003c/p\u003e\n\u003ch3\u003eData Collection\u003c/h3\u003e\n\u003cp\u003eData collection involves a retrospective review of medical records, including patient demographics (age, BMI, obstetric history, previous surgical procedures, concomitant pelvic diseases, and comorbidities), surgical characteristics, pre-postoperative symptoms (painful evacuation effort, incomplete evacuation, need for digital assistance, vaginal splinting, difficulty in defecation, use of laxatives or enemas, straining at defecation, hard stools, constipation, abdominal bloating, abdominal pain, urinary symptoms (incontinence), vaginal symptoms (dyspareunia, vaginal bulge), fecal incontinence, ınfrequent bowel movements, rectal pain, rectal bleeding, anal swelling). Additionally, various questionnaires, scoring systems, and physical examinations were used to assess the success of the procedure pre-and post-operatively, involving the Patient Assessment of Constipation\u0026ndash;Quality of Life (PAC-QOL)[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], Obstructed Defecation Syndrome (ODS) Score Questionnaire [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], Constipation Score[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], and stage of rectocele (Stage 0 (no rectocele), Stage 1 (mild rectocele), Stage 2 (moderate rectocele), or Stage 3 (severe rectocele))[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Satisfaction rates were also calculated for all patients.\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eDescriptive statistics were applied to summarize patient demographics and clinical features. Comparative analysis between pre-procedural and post-procedural variables will be conducted using appropriate statistical tests such as paired-sample t-test for continuous data and the McNemar test for categorical data. Statistical significance will be set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eEthical Considerations:\u003c/h2\u003e \u003cp\u003e This study was performed following the guidelines set forth in the Declaration of Helsinki. Ethical approval was granted by the Institutional Review Board at Akdeniz University Faculty of Medicine. All participants provided informed consent before being enrolled in the study.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eTermination Criteria\u003c/h3\u003e\n\u003cp\u003eThe study will be concluded on the patients who have completed a follow-up period of 6 months post-procedure. This detailed method section outlines the study design, participant selection criteria, data collection process, statistical analysis plan, ethical considerations, and termination criteria for the research project evaluating the effectiveness of AFG in rectocele treatment.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe findings of the retrospective investigation evaluating the effectiveness of AFG in the treatment of rectocele are presented below:\u003c/p\u003e \u003cp\u003eDemographic and clinical characteristics of the patients are demonstrated in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The average age of the patients was 51.2 years, with a standard deviation (SD) of 12.41. The mean Body Mass Index (BMI) was 27.92, with an SD of 4.91. In terms of obstetric history, the mean number of parity was 2.52 (SD\u0026thinsp;=\u0026thinsp;1.34), the mean number of vaginal deliveries was 1.66 (SD\u0026thinsp;=\u0026thinsp;1.71), and the average number of traumatic deliveries was 0.55 (SD\u0026thinsp;=\u0026thinsp;0.70). Regarding the surgical procedures, 26% of the patients underwent a hysterectomy, 11% had pelvic floor surgery, 35% had anal surgery, and 11% underwent rectocele repair with mesh (n\u0026thinsp;=\u0026thinsp;7). For concomitant pelvic diseases, 14% of the patients had vaginal prolapse, 3% had cystocele, 46% had anal fissure, 58% had hemorrhoids, 22% had mucosal rectal prolapse, and 1.5% had anal fistula. Data for rectal intussusception, pelvic decensus, enterocele, and anismus were recorded as 33,84%, 4,6%, 3,1%, and 0%, respectively. In terms of comorbidities, the percent of the patients who had hypertension and diabetes mellitus were 29.23% and 15.38%, respectively. Among all patients, 15.38% had asthma, 7.70% had cardiovascular diseases (including arrhythmia, bypass, cardiac stent, and palpitations), 10.77% had thyroid disorders, and 21.54% had other diseases such as Familial Mediterranean Fever (FMF), cholesterol issues, vertigo, epilepsy, reflux, neurogenic bladder, etc.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic characteristics of patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e51,2\u0026thinsp;\u0026plusmn;\u0026thinsp;12,41\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI(mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27,92\u0026thinsp;\u0026plusmn;\u0026thinsp;4,91\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eObstetric history(mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e* Number of parity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2,52\u0026thinsp;\u0026plusmn;\u0026thinsp;1,34\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e* Number of vaginal deliveries\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,66\u0026thinsp;\u0026plusmn;\u0026thinsp;1,71\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e* Traumatic deliveries\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0,55\u0026thinsp;\u0026plusmn;\u0026thinsp;0,70\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgical procedures(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e* Hysterectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e* Pelvic floor surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e* Anal surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e* Rectocele repair with mesh (n\u0026thinsp;=\u0026thinsp;7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConcomitant pelvic diseases(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e*Vaginal prolapse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e*Cystocele\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e*Anal fissura\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e*Hemorrhoid\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e*Mucosal rectal prolapse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e*Anal fistula\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e*Rectal intussusception\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33,84\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e*Pelvic decensus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4,6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e*Enterocele\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3,1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e*Anismus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComorbidities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e*Hypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29,23\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e*Diabetes Mellitus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15,38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e*Asthma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15,38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e*Cardiovascular Diseases (arrhythmia, bypass, cardiac stent, palpitations)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7,70\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e*Thyroid disorders\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10,77\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e*Other Diseases (FMF, cholesterol, vertigo, epilepsy, reflux, neurogenic, bladder, etc.)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21,54\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003ePre-procedural symptoms are listed in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Before surgery, patients exhibited a range of symptoms with varying frequencies. The most common symptom was difficulty in defecation (95.4%), followed closely by straining at defecation (93.8%). Constipation was another prevalent issue (90.8%). Hard stools and abdominal bloating were noted in 83.1 and 81.5%, respectively. Others are listed in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMain preoperative and postoperative symptoms and findings\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePreoperative (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePostoperative (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSignificance \u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePainful evacuation effort\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e76,9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26,2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncomplete evacuation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e76,9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21,5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeed of digital assistance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e50,8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21,5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVaginal splinting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0,05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDifficulty in defecation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e95,4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27,7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUse of laxatives or enemas\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e55,4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12,3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStraining at defecation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e93,8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHard stools\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e83,1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13,8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConstipation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e90,8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbdominal bloating\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e81,5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27,7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbdominal pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e67,7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18,5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrinary symptoms (incontinence)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e38,5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16,9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVaginal symptoms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e*Dyspareunia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e58,5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27,7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e*Vaginal bulge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0,05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFecal incontinence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10,8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4,6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0,05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInfrequent bowel movements\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e38,2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10,8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRectal pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e75,4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16,9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRectal bleeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e61,5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9,2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnal swelling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e44,6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7,2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eSurgical characteristics and post-procedural outcomes:\u003c/h2\u003e \u003cp\u003eSurgical characteristics of the patients are listed in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. The average operation time and hospital stay were 15 minutes and 2 hours, respectively. The follow-up period (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD) averaged 12.13\u0026thinsp;\u0026plusmn;\u0026thinsp;4.29 (ranged 7\u0026ndash;19) months. Complications associated with AFG were minimal, with 35% of patients experiencing minimal skin ecchymosis resulting from liposuction. The symptoms resolved with treatment using mucopolysaccharide polysulfate (chondroitin polysulfate) cream. These complications were managed conservatively without the need for additional intervention in most cases. Additionally, 18% of the patients (n\u0026thinsp;=\u0026thinsp;12) required a second procedure, and only 31% of the patients needed postoperative analgesics for 2 days.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSurgical characteristics of the patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOperation time (minutes)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHospital stay (hours)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeroperative complication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFollow up time (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD/range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12,13\u0026thinsp;\u0026plusmn;\u0026thinsp;4,29/range: 7\u0026ndash;19 months)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative complications (Ecchymosis)(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeed for a second procedure (%) (n\u0026thinsp;=\u0026thinsp;12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative analgesic use (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003ePost-procedural outcomes listed in Tables\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and \u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, and also were assessed through a combination of physical examination, patient-reported symptoms, and 3 scoring systems. The comparison between preoperative and postoperative symptoms and findings shows a significant reduction in most of the symptoms following surgery (Fig.\u0026nbsp;1).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eEvaluation of the surgical procedure using various scoring system\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePreoperative (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePostoperative (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSignificance \u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatient Assessment of Constipation\u0026ndash;Quality of Life (PAC-QOL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e99,87\u0026thinsp;\u0026plusmn;\u0026thinsp;9,86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e46,58\u0026thinsp;\u0026plusmn;\u0026thinsp;21,51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0,05\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eObstructed Defecation Syndrome Score Questionnaire (Altomare et al, 2008)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e17,91\u0026thinsp;\u0026plusmn;\u0026thinsp;6,67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e7,93\u0026thinsp;\u0026plusmn;\u0026thinsp;5,61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0,05\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConstipation Score (Agachan F,1996)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e9,69\u0026thinsp;\u0026plusmn;\u0026thinsp;4,62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4,72\u0026thinsp;\u0026plusmn;\u0026thinsp;3,69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0,05\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe results demonstrate a significant improvement in patients\u0026rsquo; stage of rectocele following the procedure (Fig.\u0026nbsp;2). Before the intervention, 41.5% of patients were classified as Stage 3, 38.5% were in Stage 2, and 20% were in Stage 1, with no patients in Stage 0. After the procedure, there was a substantial shift, with 49.2% of patients moving to Stage 1 and 26.2% achieving Stage 0. Meanwhile, 20% remained in Stage 2, and only 4.6% remained in Stage 3. These changes highlight the effectiveness of the treatment in reducing the severity of symptoms and improving the overall condition of the patients.\u003c/p\u003e \u003cp\u003eThe surgical procedure was evaluated using several scoring systems demonstrated in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e and the results showed significant improvements postoperatively. The PAC-QOL score decreased from a preoperative mean of 99.87\u0026thinsp;\u0026plusmn;\u0026thinsp;9.86 to a postoperative mean of 46.58\u0026thinsp;\u0026plusmn;\u0026thinsp;21.51, with a significance level of p\u0026thinsp;\u0026lt;\u0026thinsp;0.05. This presents a notable improvement in the patient's postoperative life quality (Fig.\u0026nbsp;3a). The ODS Score Questionnaire also showed a significant reduction, with the preoperative score decreasing from 17.91\u0026thinsp;\u0026plusmn;\u0026thinsp;6.67 to a postoperative score of 7.93\u0026thinsp;\u0026plusmn;\u0026thinsp;5.61 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). This suggests a substantial decrease in symptoms related to obstructed defecation following surgery (Fig.\u0026nbsp;3b). Similarly, the Constipation Score (Agachan F, 1996) improved significantly, with the preoperative mean score of 9.69\u0026thinsp;\u0026plusmn;\u0026thinsp;4.62 dropping to 4.72\u0026thinsp;\u0026plusmn;\u0026thinsp;3.69 postoperatively (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), indicating a reduction in constipation severity after the surgical intervention (Fig.\u0026nbsp;3c). Overall, these scoring systems demonstrate that the surgical procedure led to significant improvements in patient outcomes across various measures (Fig.\u0026nbsp;3).\u003c/p\u003e \u003cp\u003eA survey of patient satisfaction following the operation revealed varying levels of contentment (Fig.\u0026nbsp;4). Among the patients, 11% (7 patients) rated their satisfaction as poor, while 15% (10 patients) considered it sufficient. A total of 18% (12 patients) described their satisfaction as good. The majority, 56% (36 patients), reported an excellent level of satisfaction with the outcome of their surgery. These results indicate a generally high rate of satisfaction among the patients (Fig.\u0026nbsp;4a).\u003c/p\u003e \u003cp\u003eTwelve patients (18%) underwent a second fat transfer due to poor satisfaction after the first procedure. The satisfaction rates for patients who underwent a second procedure are as follows, listed from highest to lowest. A majority of 50% (6 patients) reported an excellent level of satisfaction, while 25% (3 patients) described their satisfaction as good. Additionally, 17% (2 patients) considered their satisfaction sufficient, and 8% (1 patient) rated their satisfaction as poor (Fig.\u0026nbsp;4b). Also, these patients were evaluated using various scoring systems, showing significant improvements postoperatively (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). PAC-QOL score decreased from a preoperative mean of 101.92\u0026thinsp;\u0026plusmn;\u0026thinsp;7.89 to a postoperative mean of 46.33\u0026thinsp;\u0026plusmn;\u0026thinsp;22.62, with a significance level of p\u0026thinsp;\u0026lt;\u0026thinsp;0.05. Similarly, the ODS Score Questionnaire showed a significant reduction, with the preoperative score decreasing from 17.66\u0026thinsp;\u0026plusmn;\u0026thinsp;5.58 to a postoperative score of 7.83\u0026thinsp;\u0026plusmn;\u0026thinsp;4.32 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The Constipation Score also improved significantly, with the preoperative mean score of 9\u0026thinsp;\u0026plusmn;\u0026thinsp;3.54 dropping to 4.41\u0026thinsp;\u0026plusmn;\u0026thinsp;2.46 postoperatively (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). These findings indicate that the second repeated intervention led to substantial improvements in patient outcomes across these measures.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eEvaluation of the surgical procedure using various scoring system for second procedure\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePreoperative (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePostoperative (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSignificance \u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatient Assessment of Constipation\u0026ndash;Quality of Life (PAC-QOL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e101,92\u0026thinsp;\u0026plusmn;\u0026thinsp;7,89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e46,33\u0026thinsp;\u0026plusmn;\u0026thinsp;22,62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0,05\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eObstructed Defecation Syndrome Score Questionnaire (Altomare et al, 2008)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e17,66\u0026thinsp;\u0026plusmn;\u0026thinsp;5,58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e7,83\u0026thinsp;\u0026plusmn;\u0026thinsp;4,32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0,05\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConstipation Score (Agachan F,1996)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e9\u0026thinsp;\u0026plusmn;\u0026thinsp;3,54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4,41\u0026thinsp;\u0026plusmn;\u0026thinsp;2,46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0,05\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe outcomes for patients who had rectocele repair with mesh (n\u0026thinsp;=\u0026thinsp;7; 11%) and later received autologous fat transfer due to low satisfaction were in line with the overall results. Following the procedure, the patient satisfaction results were as follows: 43% of patients (3 patients) rated their satisfaction as sufficient, and another 43% (3 patients) described it as good. Meanwhile, 14% (1 patient) reported excellent satisfaction. Notably, no patients rated their satisfaction as poor (Fig.\u0026nbsp;4c). The evaluation of these patients was conducted using various scoring systems, showing significant improvements postoperatively (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e). PAC-QOL score decreased from a preoperative mean of 101\u0026thinsp;\u0026plusmn;\u0026thinsp;8.99 to a postoperative mean of 48.57\u0026thinsp;\u0026plusmn;\u0026thinsp;16.18, with a significance level of p\u0026thinsp;\u0026lt;\u0026thinsp;0.05. The ODS Score Questionnaire also showed a significant reduction, with the preoperative score decreasing from 18.71\u0026thinsp;\u0026plusmn;\u0026thinsp;5.1 to a postoperative score of 6.86\u0026thinsp;\u0026plusmn;\u0026thinsp;2.61 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Additionally, the Constipation Score (Agachan F, 1996) improved significantly, with the preoperative mean score of 9.43\u0026thinsp;\u0026plusmn;\u0026thinsp;4.86 dropping to 3.57\u0026thinsp;\u0026plusmn;\u0026thinsp;1.40 postoperatively (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eEvaluation of the fat transfer due to insufficent mesh repair using various scoring system\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePreoperative (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePostoperative (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSignificance \u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatient Assessment of Constipation\u0026ndash;Quality of Life (PAC-QOL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e101\u0026thinsp;\u0026plusmn;\u0026thinsp;8,99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e48,57\u0026thinsp;\u0026plusmn;\u0026thinsp;16,18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0,05\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eObstructed Defecation Syndrome Score Questionnaire (Altomare et al, 2008)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e18,71\u0026thinsp;\u0026plusmn;\u0026thinsp;5,1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e6,86\u0026thinsp;\u0026plusmn;\u0026thinsp;2,61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0,05\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConstipation Score (Agachan F,1996)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e9,43\u0026thinsp;\u0026plusmn;\u0026thinsp;4,86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3,57\u0026thinsp;\u0026plusmn;\u0026thinsp;1,40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0,05\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eVarious surgical techniques have been proposed for repair of the rectocele. However, there is inadequate proof to determine which technic is the most effective or whether any specific technique is superior in certain conditions [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. The standard approach for rectocele repair is transvaginal surgery, often carried out by gynecologists in conjunction with other techniques like levatorplasty, hysterectomy, and cystocele repair [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Many researchers have documented positive anatomical outcomes after transvaginal repair [\u003cspan additionalcitationids=\"CR18\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Despite this, major issues with vaginal methods include sexual dysfunction and dyspareunia. Kahn and Stanton[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] noted postoperative dyspareunia rates varying from 12\u0026ndash;25% with a rise in the preoperative sexual dysfunction rate from 18\u0026ndash;27% after transvaginal repair [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Additionally, the recurrence rate of rectocele varied from 5.7\u0026ndash;7% following transvaginal procedures [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe transabdominal method is significantly advised for individuals with high defects in the rectovaginal fascia, manifesting as enterocele and rectocele. The laparoscopic technique might be favored over the transvaginal approach for managing complicated cases of extensive rectocele [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. The transperineal technique is rarely employed and is typically reserved for rectocele cases with incontinence caused by a defect in the anal sphincter [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], as it provides access to the levator ani and external anal sphincter, simultaneously.\u003c/p\u003e \u003cp\u003eThe transanal method enables addressing coexisting anorectal issues like intussusception and hemorrhoids [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. As a result, this approach is usually used in patients who have obstructed defecation or other anorectal issues associated with rectocele. The main contraindications for the transanal technique are puborectalis dyssynergia, enterocele and high rectoceles [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eLongo proposed a different method for treating obstructed defecation caused by intussusception and rectocele, called stapled transanal rectal resection (STARR) [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. While the STARR procedure provides significant relief from rectal symptoms by correcting rectocele and intussusception, it is associated with certain complications. Postoperative bleeding rates with the STARR technique ranged from 3.3\u0026ndash;26.6%, fecal urgency occurred in 1.1\u0026ndash;34% of patients, and flatus incontinence was observed in 6\u0026ndash;26.7% of cases [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. The rate of recurrence associated with STARR remains under 40% [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eInitially introduced as a treatment for severe rectal mucosal prolapse, the Delorme procedure involves transanal sleeve mucosectomy. Today, the Delorme technique is deemed effective for managing obstructed defecation caused by rectal intussusception and rectocele [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. The Delorme method can be performed with regional anesthesia and carries a low risk of postoperative complications [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eInjection sclerotherapy, a less invasive and affordable technique for managing rectal prolapse and hemorrhoids, is infrequently used for rectocele repair [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. According to Tsiaoussis et al., sclerotherapy with a 5% phenol-based solution in arachis oil targeting symptomatic mucosal prolapse linked to rectocele in 78% of cases achieved a 51% success rate [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Nonetheless, notable complications associated with sclerotherapy were identified. Misplaced injections during sclerotherapy might cause mucosal ulceration or necrosis, fever, or prostatitis[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOur research demonstrates that AFG is successful in alleviating and improving patient outcomes. A significant decrease was observed in key symptoms such as difficulty in defecation, incomplete evacuation, straining, constipation, abdominal pain, and rectal pain. Postoperative complications were minimal, and patient satisfaction was generally high, with most patients reporting excellent or good outcomes. A significant shift in rectocele stages was observed, with most patients moving to lower stages postoperatively, alongside high satisfaction rates reported in the surveys. Importantly, in patients who initially experienced dissatisfaction or suboptimal results from other treatments, the application of AFG showed a notably high satisfaction rate. Even among those who required a second fat transfer, the majority reported a significant improvement after the second procedure, highlighting the procedure's success. Moreover, AFG serves as a valuable complementary option to other treatments, providing an additional avenue for improving patient satisfaction and outcomes in cases where initial approaches may not fully resolve symptoms. In patients who previously underwent mesh-assisted rectocele repair but did not experience complete resolution of their symptoms, we applied AFG. Among a total of 7 patients, 6 reported a satisfaction level of good or higher following the AFG procedure.\u003c/p\u003e \u003cp\u003eThese findings suggest that AFG is not only an effective treatment for rectocele but also offers a repeatable and customizable solution for patients who do not respond to other interventions. This reinforces its role as a flexible, patient-centric treatment modality with promising long-term benefits.\u003c/p\u003e \u003cp\u003eAlthough defecography is known to be the most reliable examination for the diagnosis of rectocele[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], a rectocele identified via defecography does not always correspond to one detected through physical examination in patients presenting with defecatory symptoms[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. The majority of studies have been unable to establish a link between defecography metrics (postvoid residual, perineal descent, or rectocele size, etc.) and successful clinical outcomes after rectocele repairs [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. In a group of symptomatic women, Shannon L. Wallace and colleagues[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] found that the detection of a rectocele via defecography does not inherently confirm its presence during a physical examination. Their research highlighted that the diagnosis and surgical management of rectocele should primarily rely on clinical findings from physical examination and patient-reported symptoms. Therefore, in our study, we prioritized physical examination to highlight the effectiveness of this innovative approach in the treatment of rectocele.\u003c/p\u003e \u003cp\u003eThe application of AFG in the vulvovaginal area has been shown to help manage sexual function issues in women, improve aesthetics, restore tissue volume, relieve lubrication-related dyspareunia, and reduce scar tissue pain[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. The AFG technique in the treatment of rectocele was first described and applied by Zetlitz and colleagues in 2013[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. They use Coleman\u0026rsquo;s technique for obtaining fat grafts [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. In Coleman's technique, the harvested adipose tissue undergoes a centrifugation process. The fraction containing blood and its elements is discarded. In our technique, to obtain stem cell-enriched adipose tissue (SVF), an additional step of filtration through different-sized filters is performed. The resulting product is injected into the rectovaginal area. The posterior vaginal wall defect was successfully repaired using this minimally invasive technique. Therefore, this application in the treatment of rectocele has no known equivalent in the literature. Additionally, fat grafting offers a minimally invasive option for these patients.\u003c/p\u003e \u003cp\u003eAFG is commonly employed in reconstructive and aesthetic procedures, such as improving skin texture, reducing scar tissue, addressing soft-tissue deficits, and augmenting body parts[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e], as it is easily accessible, compatible with the body, natural in appearance, and does not provoke immune reactions [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Indeed, cell-based approaches enhance the viability of fat grafts by supplementing them with additional ADSCs [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. The SVF is composed of multipotent constituents, including ADSCs, fibroblasts, endothelial cells, immune cells, and pericytes, which can be efficiently harvested from adipose tissue [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Due to its regenerative abilities, such as growth factor secretion and stimulation of dermal angiogenesis, SVF has been utilized to manage conditions related to scarring [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Koh et al.[\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e] proposed that co-implanting SVF to enhance vascularization could improve the microenvironment and increase graft survival. Survival rates for AFG range from 24\u0026ndash;51.4%, whereas fat grafts enriched with freshly isolated SVF exhibit improved survival rates (63\u0026ndash;90.4%) compared to conventional lipofilling over 12 to 19 months of follow-up [\u003cspan additionalcitationids=\"CR38\" citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. By using this method, we aimed not only to create a barrier in the rectovaginal space by filling it, which might be temporary but also to utilize the regenerative and other beneficial properties of mesenchymal stem cells released by filtering the fat tissue.\u003c/p\u003e \u003cp\u003eThe favorable outcomes observed in our study underscore the potential of AFG as a minimally invasive alternative to traditional surgical approaches for rectocele repair. AFG offers several advantages, including its autologous nature, minimal donor site morbidity, and potential for long-term tissue integration. Moreover, AFG may be particularly beneficial for patients who are not candidates for or prefer to avoid traditional surgical interventions. However, further research is needed to delineate patient selection criteria, optimal procedural techniques, and long-term outcomes of AFG in rectocele management.\u003c/p\u003e \u003cp\u003eVarious constraints should be taken into account when interpreting the outcomes of this research. The retrospective nature of the study naturally introduces selection bias and hinders establishing causal relationships. The limited sample size and single-institution framework could restrict the generalizability of our conclusions. The lack of a control group makes it impossible to directly compare outcomes with alternative therapeutic options. Prospective research involving broader, multicenter populations and longer observation periods is necessary to address these issues and yield more conclusive data.\u003c/p\u003e \u003cp\u003eFuture research endeavors should focus on addressing the limitations of our study and further elucidating the role of AFG in rectocele treatment. Prospective comparative studies comparing AFG with conventional surgical techniques, as well as other minimally invasive approaches, are warranted to establish the relative efficacy and safety profiles. Long-term follow-up researches are needed to evaluate the durability of the outcomes and the incidence of recurrence over time. Moreover, investigations into the underlying mechanisms of action of AFG in tissue regeneration and remodeling are essential for optimizing procedural techniques and enhancing patient outcomes.\u003c/p\u003e \u003cp\u003eWe believe that the treatment of rectocele with AFG should be considered primarily as a cost-effective, repeatable, and complication-free option compared to other methods that involve surgical and non-surgical complications, significant recurrence rates, longer operation and hospitalization times, and higher costs.\u003c/p\u003e \u003cp\u003eTo summarize, our findings suggest preliminary support for the use of AFG as a treatment for rectocele. Although encouraging, additional investigations are necessary to confirm and expand upon these results, refine procedural protocols, and expand our understanding of AFG's therapeutic mechanisms. Ultimately, a multidisciplinary approach integrating clinical expertise, patient preferences, and scientific evidence will be crucial in optimizing rectocele management and improving patient outcomes.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFinancial Disclosure:\u003c/strong\u003e None reported.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding Declaration:\u003c/strong\u003e This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eConcept - OD, KO; Design - HC; Supervision - OD,MZS,VV; Proofing - OD,KO; Materials - OD,HC; Data and/or Processing - OD, KO,IZ; Analysis and/or Interpretation - OD,KO,MZS; Literature Search - OD, VV; Writing - OD,KO; Critical Reviews - OD,VV; Other - OD\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMustain WC (2016) Functional Disorders: Rectocele. 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Stem Cells Transl Med 1:341\u0026ndash;351. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.5966/sctm.2011-0065\u003c/span\u003e\u003cspan address=\"10.5966/sctm.2011-0065\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Rectocele, Autologous Fat Grafting, Efficacy, Retrospective Study","lastPublishedDoi":"10.21203/rs.3.rs-5644289/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5644289/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eRectocele, a prevalent condition linked with pelvic organ prolapse, affects many women postpartum, leading to symptoms like constipation, straining during bowel movements, and vaginal pressure, significantly impairing quality of life. Traditional surgical procedures for rectocele repair often lead to complications and symptom recurrence. Recently, autologous fat grafting (AFG) has emerged as a minimally invasive alternative. This retrospective study evaluates the efficacy and safety of AFG, using a stem cell-enriched approach for rectocele treatment.\u003c/p\u003e\u003ch2\u003eMaterial and Methods\u003c/h2\u003e \u003cp\u003eConducted at Akdeniz University Faculty of Medicine, this study included female patients who underwent AFG for rectocele from January 2023 to January 2024. Inclusion criteria were patients diagnosed with rectocele, aged 18 or older, with a follow-up period of at least 6 months post-procedure. Data were collected on patient demographics, clinical characteristics, pre- and post-procedural symptoms, procedural details, and follow-up outcomes. Statistical analysis compared pre- and post-procedural variables using appropriate tests.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe study included 65 patients, with a mean (\u0026plusmn;\u0026thinsp;SD) age of 51,2 (\u0026plusmn;\u0026thinsp;12,41) years. Pre-procedural symptoms included rectal pain, constipation, and dyspareunia. Post-procedural outcomes demonstrated significant improvements in these symptoms, with a mean (\u0026plusmn;\u0026thinsp;SD) follow-up period of 12,13 (\u0026plusmn;\u0026thinsp;4,29) months. The majority of patients reported symptom relief, particularly from rectal pain and constipation. Complications were minimal, with 25% of patients experiencing mild skin ecchymosis that resolved with treatment. Obstructive defecation, Quality of life, and constipation assessments showed significant improvements, with patients reporting higher satisfaction and improved functional outcomes.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eAFG shows promise as an effective minimally invasive treatment for rectocele. It offers significant symptom relief and improved quality of life with minimal complications. The results suggest that AFG could be a valuable alternative to traditional surgical methods.\u003c/p\u003e","manuscriptTitle":"Proving the Efficacy of Autologous Fat Grafting in the Treatment of Rectocele: A Retrospective Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-26 08:21:07","doi":"10.21203/rs.3.rs-5644289/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2abd6a8c-a028-42e3-821d-44991439dc2e","owner":[],"postedDate":"December 26th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-06-21T00:53:17+00:00","versionOfRecord":[],"versionCreatedAt":"2024-12-26 08:21:07","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5644289","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5644289","identity":"rs-5644289","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}