Center for Urogynecology and Pelvic Reconstructive Surgery, Cleveland Clinic, 9500 Euclid Ave, Desk A81, Cleveland, OH, 44195, USA.
Int Urogynecol J. 2020 Oct;31(10):2075-2080. doi: 10.1007/s00192-020-04268-7. Epub 2020 Mar 7.
To determine if a concurrent posterior repair for an asymptomatic rectocele at the time of sacrocolpopexy reduces the incidence of surgical failure.
This is a retrospective chart review with a cross-sectional follow-up survey of all patients who underwent sacrocolpopexy from 2004 to 2014. Demographic and operative data were collected from the medical record. For the cross-sectional portion, patients were contacted to obtain information on symptoms and retreatment after surgery. In this study, we included patients with an asymptomatic rectocele on examination, defined as Ap or Bp ≥ -1 on POP-Q without defecatory dysfunction, which was defined as constipation based on the Rome III criteria, dyschezia, excessive straining and/or splinting to have a bowel movement. The primary outcome was a composite score of subjective bulge symptoms or retreatment for prolapse.
Three hundred forty-four patients met the inclusion criteria: 185 (53.8%) had a sacrocolpopexy only (SCP) and 159 (46.2%) had a concurrent posterior repair (SCP + PR). The composite failure rate was 10.2% (95% CI = 7.4-13.8%), with a 13.5% (25) failure rate in the SCP group compared with 6.3% (10) in the SCP + PR group (p = 0.03). On multivariable logistic regression, the adjusted odds of failure was 2.79 in the SCP compared with the SCP + PR group (CI 1.25-6.23; P = 0.01). The rates of de novo defecatory dysfunction following surgery were low (SCP = 5.6% vs. SCP + PR = 7.5%, p = 0.55).
For patients with asymptomatic rectoceles, a concurrent posterior repair at the time of sacrocolpopexy reduces the odds of composite patient-centered failure without an increased rate of dyspareunia or de novo defecatory dysfunction.
确定在骶骨阴道固定术时同时修复无症状直肠前突是否会降低手术失败的发生率。
这是一项回顾性图表分析，并对 2004 年至 2014 年间接受骶骨阴道固定术的所有患者进行了横断面随访调查。从病历中收集人口统计学和手术数据。在横断面部分，联系患者以获取手术后症状和再治疗的信息。在本研究中，我们纳入了检查中无症状直肠前突的患者，定义为 POP-Q 上 Ap 或 Bp 值≥-1，且无排便功能障碍，排便功能障碍定义为根据罗马 III 标准的便秘、排便困难、过度用力和/或排便时支撑。主要结局是主观膨出症状或脱垂再治疗的综合评分。
符合纳入标准的患者共 344 例：185 例（53.8%）仅行骶骨阴道固定术（SCP），159 例（46.2%）行同期后修补术（SCP+PR）。复合失败率为 10.2%（95%CI=7.4-13.8%），SCP 组的失败率为 13.5%（25 例），SCP+PR 组的失败率为 6.3%（10 例）（p=0.03）。多变量逻辑回归分析显示，SCP 组的失败调整比值比为 2.79（95%CI 1.25-6.23；P=0.01）。术后新发排便功能障碍的发生率较低（SCP=5.6%比 SCP+PR=7.5%，p=0.55）。
对于无症状直肠前突的患者，在骶骨阴道固定术时同时进行后修补术可降低患者为中心的复合失败的可能性，且不会增加性交疼痛或新发排便功能障碍的发生率。
