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Transischioanal trans-sacrospinous ligament rectocele repair with polypropylene mesh: a prospective study with assessment of rectoanal function

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Abstract

Introduction and hypothesis

Despite good anatomical outcomes of pelvic organ prolapse (POP) repair by the vaginal route using synthetic mesh, complications limit their use. Clinical data are needed to generalize prolapse mesh repair by the vaginal route. The current study aims to evaluate midterm rectoanal function and clinical outcomes after transischioanal rectocele repair using a medium weight polypropylene mesh.

Methods

Between March 2003 and June 2004, 230 patients with stage II–IV anterior and/or posterior POP were included in a prospective multicenter study. The current study is based on the analysis of the 116 patients who underwent a rectocele repair via the infracoccygeal route through the sacrospinous ligament. Anatomical cure was defined when rectocele was at stage <II in the Pelvic Organ Prolapse Quantification (POP-Q) system. Postoperative functional results were evaluated using the self-administered Pelvic Floor Distress Inventory (PFDI) and the Pelvic Floor Impact Questionnaire (PFIQ).

Results

Of the 116 patients who received a posterior mesh with two arms via the infracoccygeal route through the sacrospinous ligament, midterm anatomical results were available for 78 women representing 67 % (78/116) of the operated patients. The mean follow-up was 36 (± 8.1) months. No rectal injury occurred during surgery. The objective success rate was 94.8 % and subjective (by patient satisfaction) was 93.23 %. Colorectal-Anal Impact (CRAI) and Colorectal-Anal Distress Inventory (CRADI) scores were both significantly decreased at midterm follow-up in comparison with baseline (42.7 at baseline vs 11.4 at 24- or 36-month follow-up, p = 0.001 for CRAI, and 81.1 vs 34.4, p < 0.001 for CRADI) highlighting the benefits of rectocele repair on colorectal-anal function.

Conclusions

Polypropylene mesh with two arms via the infracoccygeal route through the sacrospinous ligament has good anatomical results at midterm follow-up with significant improvement in symptoms and quality of life and is associated with few complications. Obstructive symptoms reported in cases of rectocele can be improved by transvaginal mesh repair.

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Abbreviations

POP:

Pelvic organ prolapse

POP-Q:

Pelvic Organ Prolapse Quantification system

ICS:

International Continence Society

PFIQ:

Pelvic Floor Impact Questionnaire

PFDI:

Pelvic Floor Distress Inventory

CRAIQ:

Colorectal-Anal Impact Questionnaire

CRADI:

Colorectal-Anal Distress Inventory

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Acknowledgements

We thank all the other investigators of the French Ugytex Study Group for their participation in the study: Jean-Louis Bénifla and Fabien Demaria (Rothschild Hospital, Paris), Jérome Blanchot and Pierre-Louis Broux (La Sagesse Private Hospital, Rennes), Michel Cosson and Jean-Philippe Lucot (Jeanne De Flandre University Hospital, Lille), Patrick Delporte (Public Hospital, Dunkerque), Hervé Fernandez (Antoine Béclere University Hospital, Clamart), Christine Frayret (Public Hospital, Chartres), François Hacquin (Santa Maria Private Hospital, Nice), Kazeem-Marc Maaliki (Franche Comté Private Hospital, Besançon), Loïc Marpeau and Fabrice Sergent (University Hospital, Rouen).

We thank Emilie Joyeux for her contribution to the picture.

Conflicts of interest

Renaud de Tayrac is consultant for Boston scientific. This study was funded by Sofradim-Covidien.

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Authors and Affiliations

  1. Department of Obstetrics and Gynaecology, Bocage University Hospital, Dijon, France

    Pascal Mourtialon

  2. Department of Obstetrics and Gynaecology, Carémeau University Hospital, Nîmes, France

    Vincent Letouzey & Renaud de Tayrac

  3. Department of Obstetrics and Gynaecology, Champeau Private Hospital, Béziers, France

    Georges Eglin

  4. Service de Gynecologie-Obstétrique et médecine de la reproduction humaine, Centre hospitalier universitaire, Rue du Professeur Marion BP 77908, 21079, Dijon Cedex, France

    Pascal Mourtialon

  5. Centre d’épidémiologie des populations, INSERM EA 4184, Université de Bourgogne, Dijon, France

    Pascal Mourtialon

  6. Faculté de médecine, Université de Bourgogne, Dijon, France

    Pascal Mourtialon

Authors
  1. Pascal Mourtialon
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  2. Vincent Letouzey
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  3. Georges Eglin
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  4. Renaud de Tayrac
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French Ugytex Study Group

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Correspondence to Pascal Mourtialon.

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Mourtialon, P., Letouzey, V., Eglin, G. et al. Transischioanal trans-sacrospinous ligament rectocele repair with polypropylene mesh: a prospective study with assessment of rectoanal function. Int Urogynecol J 24, 81–89 (2013). https://doi.org/10.1007/s00192-012-1813-0

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  • DOI: https://doi.org/10.1007/s00192-012-1813-0

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