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. It substantially compromises quality of life and conservative treatment options are limited. In cases surgery is required the interventions are characterized by individual approaches. Laparoscopic resection rectopexy (L-RRP) combined with laparoscopic sacrocolpopexy (L-SCP) was established in an interdisciplinary setting. Methods Women with ODS combined with POP underwent surgery using an interdisciplinary laparoscopic approach. The primary endpoint was the postoperative morbidity and mortality measured by the Clavien-Dindo classification (CDC). Further endpoints were changes in bowel evacuation, POP, and urinary incontinence at a median follow-up period of > 12 months after surgery. Additionally, a biological mesh (BM) was offered premenopausal women and those, who asked for an alternative to synthetic mesh material (SM). Results Of a total of 44 patients, 36 patients were treated with L-RRP combined with L-SCP; 28 patients with SM and 8 patients with BM. CDC grades and the frequency of postoperative complications were low. Clinical outcomes for ODS, bowel dysfunction, and fecal control improved significantly. Anatomical outcome for POP was better with 28 (78%) patients having POP-Q stage 0 after surgery. 17 patients (47%) had urinary incontinence before surgery, which was restored in 14 patients (82%). No de-novo urinary incontinence appeared. Conclusions The interdisciplinary surgical approach with L-RRP and L-SCP is safe, feasible, and effective in treating women with ODS and POP. The use of a BM was established as an alternative to the SM and offers an additional and uterine-preserving option. Trial registration trial number NCT05910021, date of registration 10/06/2023.