Evaluation of autologous fat injection as a minimally invasive technique for rectocele repair: a prospective pilot study

BACKGROUND: Rectocele repair remains challenging owing to high recurrence and morbidity associated with traditional surgical techniques. Autologous fat injection has emerged as a biologically integrative method that strengthens native pelvic tissues through regenerative mechanisms. This prospective pilot study evaluated feasibility, safety, and short-term anatomical and functional outcomes of autologous fat injection for rectocele repair. METHODS: Between October 2023 and June 2025, 25 women with symptomatic Baden-Walker grade II-III rectocele and obstructed defecation syndrome (ODS) were prospectively enrolled at Kasr Al-Ainy Hospital, Cairo University. Abdominal fat was harvested, mechanically emulsified, and injected into the rectovaginal septum using a 15-gauge blunt cannula (mean injected volume 52 ± 10 mL). Outcomes included rectocele size on magnetic resonance (MR) defecography, clinical Baden-Walker grade, predefined ODS symptom categories/defecation frequency, and complications. RESULTS: Mean rectocele size decreased from 3.28 ± 0.82 to 1.82 ± 0.47 cm (p < 0.001). Overall, 80% of patients reported complete symptomatic improvement, while 20% reported recurrent symptoms during follow-up. Transient postoperative constipation occurred in 20% of patients and resolved conservatively. No major complications occurred. Injected volume showed an exploratory association with anatomical improvement. CONCLUSIONS: Autologous fat injection for rectocele repair appears feasible and safe, with a signal of short-term anatomical and functional improvement in this pilot cohort. Larger comparative studies using validated patient-reported outcomes and standardized imaging follow-up are required.