A retrospective study evaluating the charts of 368 women who underwent a posterior repair between July 1998 and June 2002 with at least one-year follow-up. The women where evaluated in the operating room. If they had a site-specific defect that was repaired, if no specific defect was isolated, a posterior colporrhaphy was performed. The site-specific posterior repair was associated with an anatomic recurrence rate of 44% versus 28% for posterior colporrhaphy and the recurrence of a symptomatic bulge of 11% versus 4% respectively (p = 0.02). Paraiso et al in a prospective randomized trial found that the anterior colporrhaphy and site-specific repair groups had similar anatomic cures (86% vs. 78% respectively) and functional outcomes at 17.5 months. The major weakness of the site-specific defect repair is that it cannot be standardized from patient to patient (it is tailored to the patient). Like many other prolapse procedures, standardization between surgeons is very difficult (i.e. suture selection, inclusion of perineorrhaphy or midline plications). Some disagreement exists concerning whether defects are present prior to or occur as a result of the surgical dissection. The repair of posterior vaginal prolapse includes vaginal, transanal and laparoscopic approaches. The choice of approach depends on the surgeon and patient preference, surgeon’s skill level – especially in the case of laparoscopic repair, type of defect and symptomatology, as well as the need for concomitant surgery. Anatomic outcomes for traditional vs. site-specific rectocele repair do not appear to be significantly different according to the published literature to date. Levator ani plication likely contributes to de novo dyspareunia and should not be performed in sexually active women. The use of adjunctive graft material still requires more study, but the evidence thus far does not support the use of Pelvicol or Fortagen. Nevertheless, given the variety of grafts available, there are insufficient data to either recommend or refute the use of other graft materials at this time.