Outcomes of Laparoscopic Management of Multicompartmental Pelvic Organ Prolapse

Overview

Journal Surg Endosc

Publisher Springer

Specialties Gastroenterology
General Surgery
Radiology

Date 2018 Jul 13

PMID 29998390

Citations 3

Authors

J C Martin Del Olmo

M Toledano

M L Martin Esteban

M A Montenegro

J R Gomez

P Concejo

M Rodriguez de Castro

F Del Rio

Affiliations

Soon will be listed here.

Abstract

Background: Pelvic organ prolapse (POP) is an increasing medical problem with complex diagnostics and controversial surgical management. It causes a series of dysfunctions in the gynecological, urinary, and anorectal organs. Numerous procedures have been proposed to treat these conditions, but in recent years, ventral mesh rectocolposacropexy (VMRCS) has emerged as the procedure of choice for the surgical treatment of POP, especially by a laparoscopic approach. This surgical technique limits the risk of autonomic nerve damage, and the colpopexy allows the correction of concomitant prolapse of the middle compartment. However, symptoms derived from anterior compartment prolapse remain a major morbidity and sometimes require an additional procedure. The aim of this study is to evaluate the results of laparoscopic prosthetic rectocolposacropexy (LRCS) and colposacropexy (LCS) procedures performed to manage combined multicompartmental POP.

Methods: Between November 2008 and December 2017, 38 patients with symptomatic POP underwent rectocolposacropexy (RCS) or colposacropexy (CS) by a laparoscopic approach. Demographics, mortality, morbidity, hospital stay, and functional outcomes were retrospectively analyzed.

Results: The median operating time was 200 min (IQR 160-220). Additional simultaneous surgery for POP was performed in nine cases: five suburethral slings and four hysterectomies were performed. No mortality was recorded. The conversion rate was 7.89%. There were two intraoperative complications (5.26%): one enterotomy and one urinary bladder tear. Late complications occurred in 5.26% of cases. After a mean follow-up of 20 months, constipation was completely resolved or improved in 83.33% of patients, urinary stress incontinence was resolved or improved in 52.94%, and gynecological symptomatology was resolved or improved in 93.75%. The recurrence rate was 5.26%.

Conclusions: Laparoscopic mesh rectocolposacropexy and colposacropexy are safe and effective techniques associated with very low morbidity. In the medium term, they provide good results for POP and associated symptoms, but urinary symptomology has a worse outcome.

Citing Articles

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References

Enriquez-Navascues J, Elosegui J, Apeztegui F, Placer C, Borda N, Irazusta M . [Ventral rectal sacropexy (colpo-perineal) in the treatment of rectal and rectogenital prolapse]. Cir Esp. 2009; 86(5):283-9. DOI: 10.1016/j.ciresp.2009.02.014. View

Samuelsson E, Victor F, Tibblin G, Svardsudd K . Signs of genital prolapse in a Swedish population of women 20 to 59 years of age and possible related factors. Am J Obstet Gynecol. 1999; 180(2 Pt 1):299-305. DOI: 10.1016/s0002-9378(99)70203-6. View

Barber M . Pelvic organ prolapse. BMJ. 2016; 354:i3853. DOI: 10.1136/bmj.i3853. View

van Iersel J, de Witte C, Verheijen P, Broeders I, Lenters E, Consten E . Robot-Assisted Sacrocolporectopexy for Multicompartment Prolapse of the Pelvic Floor: A Prospective Cohort Study Evaluating Functional and Sexual Outcome. Dis Colon Rectum. 2016; 59(10):968-74. DOI: 10.1097/DCR.0000000000000669. View

Caudwell-Hall J, Kamisan Atan I, Martin A, Rojas R, Langer S, Shek K . Intrapartum predictors of maternal levator ani injury. Acta Obstet Gynecol Scand. 2017; 96(4):426-431. DOI: 10.1111/aogs.13103. View

Lim M, Sagar P, Gonsalves S, Thekkinkattil D, Landon C . Surgical management of pelvic organ prolapse in females: functional outcome of mesh sacrocolpopexy and rectopexy as a combined procedure. Dis Colon Rectum. 2007; 50(9):1412-21. DOI: 10.1007/s10350-007-0255-0. View

Mellgren A, Johansson C, Dolk A, Anzen B, Bremmer S, Nilsson B . Enterocele demonstrated by defaecography is associated with other pelvic floor disorders. Int J Colorectal Dis. 1994; 9(3):121-4. DOI: 10.1007/BF00290186. View

DHoore A, Cadoni R, Penninckx F . Long-term outcome of laparoscopic ventral rectopexy for total rectal prolapse. Br J Surg. 2004; 91(11):1500-5. DOI: 10.1002/bjs.4779. View

Bump R, Mattiasson A, Bo K, Brubaker L, DeLancey J, Klarskov P . The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol. 1996; 175(1):10-7. DOI: 10.1016/s0002-9378(96)70243-0. View

10.

Dubuisson J, Eperon I, Dallenbach P, Dubuisson J . Laparoscopic repair of vaginal vault prolapse by lateral suspension with mesh. Arch Gynecol Obstet. 2012; 287(2):307-12. DOI: 10.1007/s00404-012-2574-1. View

11.

Aigmueller T, Dungl A, Hinterholzer S, Geiss I, Riss P . An estimation of the frequency of surgery for posthysterectomy vault prolapse. Int Urogynecol J. 2009; 21(3):299-302. DOI: 10.1007/s00192-009-1033-4. View

12.

Rojas R, Kamisan Atan I, Shek K, Dietz H . The prevalence of abnormal posterior compartment anatomy and its association with obstructed defecation symptoms in urogynecological patients. Int Urogynecol J. 2015; 27(6):939-44. DOI: 10.1007/s00192-015-2914-3. View

13.

Ramanah R, Ballester M, Chereau E, Bui C, Rouzier R, Darai E . Anorectal symptoms before and after laparoscopic sacrocolpoperineopexy for pelvic organ prolapse. Int Urogynecol J. 2012; 23(6):779-83. DOI: 10.1007/s00192-011-1657-z. View

14.

Crafoord K, Sydsjo A, Johansson T, Brynhildsen J, Kjolhede P . Factors associated with symptoms of pelvic floor dysfunction six years after primary operation of genital prolapse. Acta Obstet Gynecol Scand. 2008; 87(9):910-5. DOI: 10.1080/00016340802311243. View

15.

Forsgren C, Zetterstrom J, Zhang A, Iliadou A, Lopez A, Altman D . Anal incontinence and bowel dysfunction after sacrocolpopexy for vaginal vault prolapse. Int Urogynecol J. 2010; 21(9):1079-84. DOI: 10.1007/s00192-010-1167-4. View

16.

Brown R, Ellis C . Ventral mesh rectopexy: procedure of choice for the surgical treatment of pelvic organ prolapse?. Dis Colon Rectum. 2014; 57(12):1442-5. DOI: 10.1097/DCR.0000000000000247. View

17.

Evans C, Stevenson A, Sileri P, Mercer-Jones M, Dixon A, Cunningham C . A Multicenter Collaboration to Assess the Safety of Laparoscopic Ventral Rectopexy. Dis Colon Rectum. 2015; 58(8):799-807. DOI: 10.1097/DCR.0000000000000402. View

18.

Gultekin F, Wong M, Podevin J, Barussaud M, Boutami M, Lehur P . Safety of laparoscopic ventral rectopexy in the elderly: results from a nationwide database. Dis Colon Rectum. 2015; 58(3):339-43. DOI: 10.1097/DCR.0000000000000308. View

19.

Lauretta A, Bellomo R, Galanti F, Tonizzo C, Infantino A . Laparoscopic low ventral rectocolpopexy (LLVR) for rectal and rectogenital prolapse: surgical technique and functional results. Tech Coloproctol. 2012; 16(6):477-83. DOI: 10.1007/s10151-012-0918-2. View

20.

Watadani Y, Vogler S, Warshaw J, Sueda T, Lowry A, Madoff R . Sacrocolpopexy with rectopexy for pelvic floor prolapse improves bowel function and quality of life. Dis Colon Rectum. 2013; 56(12):1415-22. DOI: 10.1097/DCR.0b013e3182a62dbb. View