Interdisciplinary laparoscopic resection-rectopexy combined with sacrocolpopexy for obstructed defecation syndrome in women with pelvic organ prolapse: a pilot study

Ludwig S1, Madukkakuzhy J2, Ulrici C2, Karapanos L3, Rudroff C4

Research Type

Clinical

Abstract Category

Anorectal / Bowel Dysfunction

Abstract 565
Open Discussion ePosters
Scientific Open Discussion Session 34
Saturday 10th September 2022
13:30 - 13:35 (ePoster Station 5)
Exhibition Hall
Anal Incontinence Constipation Female Pelvic Organ Prolapse Surgery
1. University Hospital of Cologne, Dept. Obstetrics and Gynecology, Germany, 2. Clinic for General and Visceral Surgery Evangelisches Klinikum Köln Weyertal, Cologne, Germany, 3. University Hospital of Cologne, Depf. of Urology, Germany, 4. Clinic for General and Visceral Surgery Hospital Weyertal, Cologne, Germany
Online
Presenter
Links

Abstract

Hypothesis / aims of study
Obstructive defecation syndrome (ODS) is a disturbed defecation process due to a protrusion of the lower rectum or intussusception and frequently associated with chronic obstipation and pelvic organ prolapse (POP) in women. The quality of life of affected patients is substantially compromised, especially among younger patients. Conservative treatment options are often limited to slightly improvement of patients´ symptoms, and do not achieve cure. Surgical interventions aim to the anatomical reconstruction of the bowel and pelvic holding apparatus. So far, these surgical interventions are characterized by individual approaches and methods of each individual department and sufficient data on standardized interdisciplinary treatment options are missing.

The study investigates the feasibility of a standardized laparoscopic resection rectopexy combined with mesh sacrocolpopexy (either biological/resorbable mesh or synthetic mesh) in an interdisciplinary setting. So far, there is no interdisciplinary approach for ODS in women and the use of a biological/resorbable mesh in combination with a resection rectopexy. For the first time, this is a promising novel treatment alternative, in an interdisciplinary setting especially in premenopausal women.
Study design, materials and methods
Women who presented with an ODS combined with POP were operated in an interdisciplinary approach. All patients underwent laparoscopic resection rectopexy with mesh sacrocolpopexy using either synthetic or biologic mesh. Primary endpoint is postoperative morbidity and mortality measured by the Clavien-Dindo-Classification (CDC) at 12 months after surgery. Further endpoints are relapse of prolapse and improvement of bowel evacuation based on scores (Altomare, modified Longo, rectal toxicity score; quality of life according to the SF 312 and PHQ 9 score), the control imaging with MRI defecography, and the costs of treatment between the two groups assessed by time-derived basic costs (TDBC).
Results
Between 2020 and 2021, 26 patients were operated on this interdisciplinary approach with a median follow-up of 14 months (7 – 19 months). In five cases a biological mesh was used (3 due to patients’ preference and 2 due to planned pregnancy). Grades of complications according to CDC and frequency of postoperative complications were low. Anatomical outcomes were excellent.
Interpretation of results
The combined approach is safe, feasible, and effective to treat the medical condition.
Concluding message
For the first time, the medical condition of the patients involved is addressed with an interdisciplinary surgical approach instead of a variety of individual treatment approaches which are seldom discussed and addressed between disciplines. Additionally, a biological mesh as an alternative to the standardized synthetic mesh is offered for sacrocolpopexy. The use of a biological mesh in combination with a resection rectopexy is safe and feasible and offers an additional treatment option, especially for younger and fertile women.
Figure 1 Resection-rectopexy with unilateral zervicosacropexy
Figure 2 Characteristics and clinical outcome of patients with resection-rectopexy and unilateral sacrocolpopexy for obstructed defgecation syndrome and pelvic organ prolapse
Disclosures
Funding N/A Clinical Trial Yes Registration Number Ethical Committee of Medical Faculty University of Cologne; No. 21-1386 RCT No Subjects Human Ethics Committee Ethical Committee of Medical Faculty University of Cologne Helsinki Yes Informed Consent Yes
11/11/2024 01:20:42