Sacrocolpopexy with rectopexy for pelvic floor prolapse improves bowel function and quality of life.

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.