BACKGROUND: Sacrocolpopexy with rectopexy is advocated for combined rectal and vaginal prolapse, but limited outcome data have been reported.
OBJECTIVE: The purpose of this study was to evaluate the indications and outcomes of sacrocolpopexy and rectopexy by comparing pre- and postoperative function and quality of life.
DESIGN: A retrospective review of prospectively collected data was performed of all patients undergoing sacrocolpopexy and rectopexy at our institution from 2004 to 2011.
INTERVENTIONS AND OUTCOME MEASURES: Preoperatively, all patients underwent physiology testing and completed 4 validated questionnaires assessing bowel symptom severity and associated quality of life. Patients completed the same questionnaires in 2012.
RESULTS: A total of 110 women (median age, 55 years; range, 28-88) underwent a sacrocolpopexy and rectopexy, 33 with concomitant hysterectomy. All patients had rectal prolapse (n = 96) or rectal intussusception (n = 14), and each also had either enterocele (n = 86) or vaginal prolapse (n = 48). Rectal prolapse with enterocele was the most common presentation (n = 75). Previous surgery included rectal prolapse repair (21%) and hysterectomy (57%). Complications included presacral bleeding (n = 2), ureteral injury (n = 2), wound infection (n = 8), and pulmonary embolism (n = 2). There were no mortalities. Fifty-two patients completed the follow-up questionnaires, with a median follow-up of 29 (range, 4-90) months, and preoperative surveys were available in 30 of these patients. Preoperatively, 93% reported constipation; 82% reported resolution or improvement postoperatively. Constipation severity, measured with the Patient Assessment of Constipation Symptom Questionnaire, demonstrated improvement (1.86-1.17; p < 0.001). Fecal incontinence severity scores (Fecal Incontinence Severity Index) improved (39-24; p < 0.01), and 82% of incontinent patients reported cure or improvement. Quality-of-life scores also improved significantly. No patient developed recurrent rectal prolapse.
LIMITATIONS: This was a retrospective review, and the response rate to questionnaires was limited.
CONCLUSIONS: Sacrocolpopexy and rectopexy for combined middle and posterior compartment prolapse is a safe procedure, with low risk for recurrence, and improves bowel function and quality of life in most patients.
Written by:
Watadani Y, Vogler SA, Warshaw JS, Sueda T, Lowry AC, Madoff RD, Mellgren A. Are you the author?
Department of Surgery, Hiroshima University, Hiroshima, Japan; Department of Surgery, University of Utah, Salt Lake City, Utah; Department of Gynecology, Abbott Northwestern Hospital, Minneapolis, Minnesota; Division of Colon and Rectal Surgery, University of Minnesota, Minneapolis, Minnesota.
Reference: Dis Colon Rectum. 2013 Dec;56(12):1415-22.
doi: 10.1097/DCR.0b013e3182a62dbb
PubMed Abstract
PMID: 24201397
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