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Surgical Endoscopy

, Volume 33, Issue 4, pp 1075–1079 | Cite as

Outcomes of laparoscopic management of multicompartmental pelvic organ prolapse

  • J. C. Martín del OlmoEmail author
  • M. Toledano
  • M. L. Martín Esteban
  • M. A. Montenegro
  • J. R. Gómez
  • P. Concejo
  • M. Rodríguez de Castro
  • F. del Rio
Article

Abstract

Background

Pelvic organ prolapse (POP) is an increasing medical problem with complex diagnostics and controversial surgical management. It causes a series of dysfunctions in the gynecological, urinary, and anorectal organs. Numerous procedures have been proposed to treat these conditions, but in recent years, ventral mesh rectocolposacropexy (VMRCS) has emerged as the procedure of choice for the surgical treatment of POP, especially by a laparoscopic approach. This surgical technique limits the risk of autonomic nerve damage, and the colpopexy allows the correction of concomitant prolapse of the middle compartment. However, symptoms derived from anterior compartment prolapse remain a major morbidity and sometimes require an additional procedure. The aim of this study is to evaluate the results of laparoscopic prosthetic rectocolposacropexy (LRCS) and colposacropexy (LCS) procedures performed to manage combined multicompartmental POP.

Methods

Between November 2008 and December 2017, 38 patients with symptomatic POP underwent rectocolposacropexy (RCS) or colposacropexy (CS) by a laparoscopic approach. Demographics, mortality, morbidity, hospital stay, and functional outcomes were retrospectively analyzed.

Results

The median operating time was 200 min (IQR 160–220). Additional simultaneous surgery for POP was performed in nine cases: five suburethral slings and four hysterectomies were performed. No mortality was recorded. The conversion rate was 7.89%. There were two intraoperative complications (5.26%): one enterotomy and one urinary bladder tear. Late complications occurred in 5.26% of cases. After a mean follow-up of 20 months, constipation was completely resolved or improved in 83.33% of patients, urinary stress incontinence was resolved or improved in 52.94%, and gynecological symptomatology was resolved or improved in 93.75%. The recurrence rate was 5.26%.

Conclusions

Laparoscopic mesh rectocolposacropexy and colposacropexy are safe and effective techniques associated with very low morbidity. In the medium term, they provide good results for POP and associated symptoms, but urinary symptomology has a worse outcome.

Keywords

Rectocolposacropexy Colposacropexy Laparoscopic rectopexy Pelvic organ prolapse 

Notes

Compliance with ethical standards

Disclosures

Dr. Martín del Olmo, Dr. Toledano, Dra. Martín Esteban, Dra. Montenegro, Dra. Concejo, Dr. Gómez, Dra. Rodríguez de Castro, and Dr. del Río declare that they have no conflicts of interest or financial ties to disclose.

References

  1. 1.
    Sagar PM, Thekkinkattil DK, Heath RM, Woodfield J, Gonsalves S, Landon CR (2008) Feasibility and functional outcome of laparoscopic sacrocolpopexy for combined vaginal and rectal prolapse. Disease Colon Rectum 51:1414–1420CrossRefGoogle Scholar
  2. 2.
    Enríquez-Navascues JM, Elósegui JL, Apeztegui FJ, Placer C, Borda N, Irazusta M, Múgica JA, Murgpitio J (2009) Ventral rectal sacropexy (colpo-perineal) in the treatment of rectal and rectogenital prolapse. Cir Esp 86(5):283–298CrossRefGoogle Scholar
  3. 3.
    Samuelsson EC, Victor FT, Tibblin G, Svärdsudd KF (1999) Signs of genital prolapse in a Swedish population of women 20 to 59 years of age and possible related factors. Am J Obstet Gynecol 180:299–305CrossRefGoogle Scholar
  4. 4.
    Barber MD (2016) Pelvic organ prolapse. BMJ 354:i3853CrossRefGoogle Scholar
  5. 5.
    van Iersel JJ, de Witte CJ, Verheijen PM, Broeders IA, Lenters E, Consten EC, Schraffordt Koops SE (2016) Robot-assisted sacrocolporectopexy for multicompartment prolapse of the pelvic floor: a prospective cohort study evaluating functional and sexual outcome. Dis Colon Rectum 59(10):968–974CrossRefGoogle Scholar
  6. 6.
    Whiteman MK, Hillis SD, Jamieson DJ, Morrow B, Podgornik MN, Brett KM, Marchbanks PA (2008) Inpatient hysterectomy surveillance in the United States, 2000–2004. Am J Obstet Gynecol 198(1):e1–e7 (Epub Nov 5, 2007)CrossRefGoogle Scholar
  7. 7.
    Caudwell-Hall J, Kamisan Atan I, Martin A, Guzman Rojas R, Langer S, Shek K, Dietz HP (2017) Intrapartum predictors of maternal levator ani injury. Acta Obstet Gynecol Scand 96(4):426–431 (Epub Mar 10, 2017).CrossRefGoogle Scholar
  8. 8.
    Lim M, Sagar PM, Gonsalves S, Thekkinkattil D, Landon C (2007) Surgical management of pelvic organ prolapse in females: functional outcome of mesh sacrocolpopexy and rectopexy as a combined procedure. Dis Colon Rectum 50:1412–1421CrossRefGoogle Scholar
  9. 9.
    Mellgren A, Johansson C, Dolk A, Anzén B, Bremmer S, Nilsson BY, Holmström B (1994) Enterocele demonstrated by defecography is associated with other pelvic floor disorders. Int J Colorectal Dis 9:121–124CrossRefGoogle Scholar
  10. 10.
    Mellgren A, Bremmer S, Johansson C, Dolk A, Udén R, Ahlbäck SO, Holmström B (1994) Defecography: results of investigations in 2816 patients. Dis Colon Rectum 37:1133–1141CrossRefGoogle Scholar
  11. 11.
    D’Hoore A, Cadoni R, Penninckx F (2004) Long-term outcome of laparoscopic ventral rectopexy for total rectal prolapse. Br J Surg 91:1500–1505CrossRefGoogle Scholar
  12. 12.
    Bump RC, Mattiasson A, Bø K, Brubaker LP, DeLancey JO, Klarskov P, Shull BL, Smith AR (1996) The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 175(1):10–17CrossRefGoogle Scholar
  13. 13.
    Dubuisson J, Eperon I, Dällenbach P, Dubuisson JB (2013) Laparoscopic repair of vaginal vault prolapse by lateral suspension with mesh. Arch Gynecol Obstet 287(2):307–312.  https://doi.org/10.1007/s00404-012-2574-1 (Epub Sep 22, 2012)CrossRefGoogle Scholar
  14. 14.
    Altman D, Falconer C, Cnattingius S, Granath F (2008) Pelvic organ prolapse surgery following hysterectomy on benign indications. Am J Obstet Gynecol 198(5):e1–e6.  https://doi.org/10.1016/j.ajog.2008.01.012 (Epub Mar 20, 2008)CrossRefGoogle Scholar
  15. 15.
    Aigmueller T, Dungl A, Hinterholzer S, Geiss I, Riss P (2010) An estimation of the frequency of surgery for posthysterectomy vault prolapse. Int Urogynecol J 21(3):299–302.  https://doi.org/10.1007/s00192-009-1033-4 CrossRefGoogle Scholar
  16. 16.
    Guzman Rojas R, Kamisan Atan I, Shek KL, Dietz HP (2016) The prevalence of abnormal posterior compartment anatomy and its association with obstructed defecation symptoms in urogynecological patients. Int Urogynecol J 27:939–944CrossRefGoogle Scholar
  17. 17.
    Ramanah R, Ballester M, Chereau E, Bui C, Rouzier R, Daraï E (2012) Anorectal symptoms before and after laparoscopic sacrocolpoperineopexy for pelvic organ prolapse. Int Urogynecol J 23:779–783CrossRefGoogle Scholar
  18. 18.
    Crafoord K, Sydsjö A, Johansson T, Brynhildsen J, Kjølhede P (2008) Factors associated with symptoms of pelvic floor dysfunction six years after primary operation of genital prolapse. Acta Obstet Gynecol Scand 87:910–915CrossRefGoogle Scholar
  19. 19.
    Forsgren C, Zetterström J, Zhang A, Iliadou A, Lopez A, Altman D (2010) Anal incontinence and bowel dysfunction after sacrocolpopexy for vaginal vault prolapse. Int Urogynecol J 21:1079–1084CrossRefGoogle Scholar
  20. 20.
    Committee on Practice Bulletins-Gynecology and the American Urogynecologic Society Practice Bulletin no. 176 (2017) Pelvic organ prolapse. Obstet Gynecol 129:e56CrossRefGoogle Scholar
  21. 21.
    Brown RA, Ellis CN (2014) Ventral mesh rectopexy: a procedure of choice for the surgical treatment of pelvic organ prolapse? Dis Colon Rectum 57(12):1442–1445CrossRefGoogle Scholar
  22. 22.
    Evans C, Stevenson AR, Sileri P, Mercer-Jones MA, Dixon AR, Cunningham C, Jones OM, Lindsey I (2015) A multicenter collaboration to assess the safety of laparoscopic ventral rectopexy. Dis Colon Rectum 58(8):799–807CrossRefGoogle Scholar
  23. 23.
    Gultekin FA, Wong MT, Podevin J, Barussaud ML, Boutami M, Lehur PA, Meurette G (2015) Safety of laparoscopic ventral rectopexy in the elderly: results from a nationwide database. Dis Colon Rectum 58(3):339–343CrossRefGoogle Scholar
  24. 24.
    Lauretta A, Bellomo RE, Galanti F, Tonizzo CA, Infantino A (2012) Laparoscopic low ventral rectocolpopexy (LLVR) for rectal and rectogenital prolapse: surgical technique and functional results. Tech Coloproctol 16(6):477–483CrossRefGoogle Scholar
  25. 25.
    Watadani Y, Vogler SA, Warshaw JS, Sueda T, Lowry AC, Madoff RD, Mellgren A (2013) Sacrocolpopexy with rectopexy for pelvic floor prolapse improves bowel function and quality of life. Dis Colon Rectum 56:1415–1422CrossRefGoogle Scholar
  26. 26.
    Ayav A, Bresler L, Brunaud L, Zarnegar R, Boissel P (2005) Surgical management of combined rectal and genital prolapse in young patients: transabdominal approach. Int J Colorectal Dis 20:173–179CrossRefGoogle Scholar
  27. 27.
    Slawik S, Soulsby R, Carter H, Payne H, Dixon AR (2008) Laparoscopic ventral rectopexy, posterior colporrhaphy and vaginal sacrocolpopexy for the treatment of recto-genital prolapse and mechanical outlet obstruction. Colorectal Dis 10:138–143Google Scholar
  28. 28.
    Formijne Jonkers HA, Poierrié N, Draaisma WA, Broeders IA, Consten EC (2013) Laparoscopic ventral rectopexy for rectal prolapse and symptomatic rectocele: an analysis of 245 consecutive patients. Colorectal Dis 15(6):695–699CrossRefGoogle Scholar
  29. 29.
    Gurland B (2014) Ventral mesh rectopexy: is this the new standard for surgical treatment of pelvic organ prolapse? Dis Colon Rectum 57(12):1446–1447CrossRefGoogle Scholar
  30. 30.
    Varma M, Rafferty J, Buie WD (2011) Practice parameters for the management of rectal prolapse.; standards practice task force of american society of colon and rectal surgeons. Dis Colon Rectum 54(11):1339–1346CrossRefGoogle Scholar
  31. 31.
    Luber KM, Boero S, Choe JY (2001) The demographics of pelvic floor disorders: current observations and future projections. Am J Obstet Gynecol 184:1496–1501CrossRefGoogle Scholar
  32. 32.
    Sullivan ES, Longaker CJ, Lee PY (2001) Total pelvic mesh repair: a ten-year experience. Dis Colon Rectum 44:857–863CrossRefGoogle Scholar
  33. 33.
    Silvis R, Gooszen HG, Kahraman T, Groenendijk AG, Lock MT, Italiaander MV, Janssen LW (1998) Novel approach to combined defaecation and micturition disorders with rectovaginovesicopexy. Br J Surg 85:813–817CrossRefGoogle Scholar
  34. 34.
    Brubaker L, Cundiff GW, Fine P, Nygaard I, Richter HE, Visco AG, Zyczynski H, Brown MB, Weber AM, Pelvic Floor Disorders Network (2006) Abdominal sacrocolpopexy with Burch colposuspension to reduce urinary stress incontinence. N Engl J Med 354(15):1557–1566CrossRefGoogle Scholar
  35. 35.
    Unger CA, Paraiso MF, Jelovsek JE, Barber MD, Ridgeway B (2014) Perioperative adverse events after minimally invasive abdominal sacrocolpopexy. Am J Obstet Gynecol.  https://doi.org/10.1016/j.ajog.2014.07.054 (Epub Aug 1, 2014)Google Scholar
  36. 36.
    Nazemi TM, Kobashi KC (2007) Complications of grafts used in female pelvic floor reconstruction: mesh erosion and extrusion. Indian J Urol 23(2):153–160CrossRefGoogle Scholar
  37. 37.
    Cronjé HS, de Beer JA (2008) Culdocele repair in female pelvic organ prolapse. Int J Gynecol Obstet 100:262–266CrossRefGoogle Scholar
  38. 38.
    Fairchild PS, Kamdar NS, Berger MB, Morgan DM (2016) Rates of colpopexy and colporrhaphy at the time of hysterectomy for prolapse. Am J Obstet Gynecol 214:262.e1CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of General SurgeryMedina del Campo HospitalValladolidSpain
  2. 2.Department of Obstetrics and GynecologyMedina del Campo HospitalValladolidSpain
  3. 3.Department of UrologyMedina del Campo HospitalValladolidSpain
  4. 4.MadridSpain

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