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Early safety and efficiency outcomes of a novel interdisciplinary laparoscopic resection rectopexy combined with sacrocolpopexy for women with obstructive defecation syndrome and pelvic organ prolapse: a single center study

Authors: Rudroff, Claudia; Madukkakuzhy, Joshy; Hernandez, Alberto Vega; Otten, Jakob; Ulrici, Christoph; Karapanos, Leonidas; Ludwig, Sebastian;

Early safety and efficiency outcomes of a novel interdisciplinary laparoscopic resection rectopexy combined with sacrocolpopexy for women with obstructive defecation syndrome and pelvic organ prolapse: a single center study

Abstract

Abstract Background Obstructive defecation syndrome (ODS) defines a disturbed defecation process frequently associated with pelvic organ prolapse (POP) in women that substantially compromises quality of life. Conservative management offers limited relief and a surgical intervention may be required. This is characterized by individual approaches. Aim of the study This retrospective single center study evaluated the surgical and clinical short-term outcome of a novel interdisciplinary laparoscopic resection rectopexy (L-RRP) with mesh- sacrocolpopexy (L-SCP) for women suffering from ODS and POP. Methods The study participants underwent surgery in an interdisciplinary laparoscopic approach. Safety was the primary endpoint, assessed via postoperative morbidity classified by Clavien-Dindo scale. Secondary outcomes included evaluation of bowel function, fecal and urinary incontinence and pelvic organ prolapse status at 12 months follow-up. Additionally, a biological mesh (BM) was offered to women, who asked for an alternative to synthetic mesh material (SM). Results Of the 44 consecutive patients requiring surgery for ODS and POP, 36 patients underwent the interdisciplinary surgical approach; 28 patients with SM and 8 patients with BM. In total 5 complications occurred, four of them were classified as minor. One minor complication was observed in the BM group. One anastomotic leakage occurred in the SM group. The two ODS scores, the bowel dysfunction score, and the incontinence score improved significantly (p = 0.006, p = 0.003, p < 0.001, and p = 0.0035, respectively). Pelvic floor anatomy was fully restored (POP-Q 0) for 29 (80%) patients after surgery. 17 patients (47%) suffered from urinary incontinence before surgery, which was restored in 13 patients (76.5%). Conclusions The interdisciplinary approach with L-RRP and L-SCP and the use of a BM in a small subgroup were technically feasible, safe, and effective in this single center setting. The study’s retrospective design, the small sample size and the lack of comparators limit the generalizability of the findings requiring future randomized trials. Trial registration Retrospectively registered at clinicaltrials.gov, trial number NCT05910021, date of registration 06/10/2023.

Keywords

Obstructed defecation syndrome, Synthetic mesh, RD1-811, Pelvic Organ Prolapse, Gynecologic Surgical Procedures, Postoperative Complications, Humans, Defecation, Aged, Retrospective Studies, Sacrocolpopexy, Resection rectopexy, Vagina/surgery [MeSH] ; Aged [MeSH] ; Constipation/surgery [MeSH] ; Postoperative Complications/epidemiology [MeSH] ; Pelvic Organ Prolapse/surgery [MeSH] ; Defecation/physiology [MeSH] ; Biological mesh ; Surgical Mesh [MeSH] ; Gynecologic Surgical Procedures/methods [MeSH] ; Sacrocolpopexy ; Postoperative Complications/etiology [MeSH] ; Female [MeSH] ; Laparoscopy/methods [MeSH] ; Pelvic Organ Prolapse/complications [MeSH] ; Rectum/surgery [MeSH] ; Humans [MeSH] ; Syndrome [MeSH] ; Treatment Outcome [MeSH] ; Retrospective Studies [MeSH] ; Middle Aged [MeSH] ; Constipation/etiology [MeSH] ; Obstructed defecation syndrome ; Research ; Resection rectopexy ; Synthetic mesh ; Pelvic organ prolapse, Research, Rectum, Syndrome, Middle Aged, Surgical Mesh, Pelvic organ prolapse, Treatment Outcome, Vagina, Biological mesh, Surgery, Female, Laparoscopy, Constipation

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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
5
Top 10%
Average
Top 10%
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gold