Abstract
Abstract
Purpose
Obstructive defecation syndrome (ODS) defines a disturbed defecation process frequently associated with pelvic organ prolapse (POP) in women. It substantially compromises quality of life. Conservative treatment options are limited. Surgical interventions are characterized by a variety of individual approaches. This study standardized laparoscopic resection rectopexy (L-RRP) combined with laparoscopic sacrocolpopexy (L-SCP) in an interdisciplinary setting. Additionally, offering both synthetic mesh (SM) and biological mesh (BM) material for L-SCP is a novel treatment alternative, particularly for premenopausal women.
Methods
Women with ODS combined with POP underwent surgery using an interdisciplinary approach. The primary endpoint was postoperative morbidity and mortality measured by the Clavien-Dindo classification (CDC). Further endpoints were improvement in bowel evacuation, POP, and urinary incontinence at a median follow-up period of > 12 months.
Results
Of a total of 44 patients, 36 patients were treated with L-RRP combined with L-SCP (28 patients with SM, 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 significantly 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.
Conclusion
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 biomesh was established as an effective alternative to the SM and offers an additional and new uterine-preserving option.
Publisher
Research Square Platform LLC