Does Concomitant Pelvic Organ Prolapse Repair at the time of Rectopexy Impact Rectal Prolapse Recurrence Rates? A Retrospective Review of a Prospectively Collected Pelvic Floor Disorders Consortium Quality Improvement Database.

Journal: Diseases Of The Colon And Rectum

Background: Pelvic organ prolapse is reported in 30% of women presenting with rectal prolapse and combined repair is a viable option to avoid the need for future pelvic floor interventions. However, the added impact of adding a modicum of middle compartgment suspension by closing the pouch of Douglas during a rectal prolapse repair has not been studied.

Objective: We aimed to assess the impact of middle compartment suspension on the durability of the rectal prolapse repair. We also aimed to determine whether adding some form of pouch of Douglas closure to achieve middle compartment suspension leads to any improvements in the rates or the severity of postoperative constipation or in the rates or severity of postoperative fecal incontinence.

Methods: Retrospective analysis of a prospective database. Methods: Multicenter Pelvic Floor Disorders Consortium Prospective Quality Improvement, database. Deidentified surgeons at >20 sites (75% academic, 81% high volume) self reported patient demographics, prior repairs, symptoms of fecal incontinence and obstructed defecation, and operative details, including addition of concomitant gynecologic repairs, use of mesh, posterior or ventral dissection, and sigmoidectomy. Methods: Abdominal rectopexy procedures with and without middle compartment suspension) were compared. Middle compartment suspension was defined as excision and closure of pouch of Douglas with some degree of colpopexy or culdoplasty.

Results: The primary outcome of prolapse recurrence and secondary outcomes of incontinence and constipation were calculated via univariate and multivariable regression by comparing those who underwent rectopexy with and without middle compartment suspension. Methods: Patients who underwent abdominal repair for rectal prolapse. Results: Of the 198 patients (98% female, age 60.2 ± 15.6 years) who underwent abdominal repairs (59% robotic), 138 (70%) underwent some concomitant middle compartment suspension. Patients who had an added middle compartment suspension appeared to have lower early rectal prolapse recurrences and on multivariable regression to control for age, prior repairs, and the use of mesh, addition of some form of pouch of douglas repair was associated with a decrease in short term recurrences .

Conclusions: Our results suggest that some middle compartment suspension at the time of rectal prolapse repair may improve short term durability of rectal prolapse repair. Conclusions: Our data needs to be interpreted cautiously. Future studies are critically needed to further explore this observation, with an a priori, prospective definition of middle compartment suspension, validated measurement of concomitant pathology, and longer follow up. See Video Abstract at

Liliana Bordeianou, James Ogilvie, Margarita Murphy, Neil Hyman, Sarah Vogler, Alex Ky, Lucia Oliveira, Brooke Gurland