PurposeSymptomatic rectocele results in obstructed defecation and constipation. Surgical repair may provide symptomatic relief. A variety of surgical procedures have been used in the rectocele repair to enhance anatomical and functional results and to improve long-term outcomes.MethodsIn this prospective study, we treated 25 selected women suffering from simple symptomatic rectocele with transperineal repair using porcine dermal acellular collagen matrix Biomesh (Permacol (R)). Watson score and SF-36 questionnaire were used to evaluate postoperative outcomes and quality of life.ResultsFollow-up ranged from 12 to 24months, the mean total Watson score was significantly lower than the preoperative score (P<0.001), and every patient has improved functional outcomes. There were no major intraoperative or postoperative complications. Two cases of urinary infection and 4 patients delayed wound healing were reported. Those patients who were sexually active prior to surgery have not experienced problems with sexual function or dyspareunia.ConclusionsDespite lack of comparative study in literature, rectocele repair with Permacol (R) by the transperineal approach seems an effective and safe procedure that avoids some of the complications associated with synthetic mesh use.