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Three years prospective clinical and radiologic follow-up of laparoscopic sacrocolpoperineopexy

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Abstract

Background

When Rectocele is part of a complex pelvic organ prolapse, a full repair is recommended. The aim of this study was to evaluate the clinical and radiological results after laparoscopic surgery in patients with symptomatic rectocele and III/IV stage vaginal vault prolapse

Methods

This is a prospective cohort study of women with symptomatic rectoceles and middle compartment prolapse operated on between 2013 and 2015, who underwent a laparoscopic sacrocolpoperineopexy with synthetic Y mesh attached to puborectalis muscles, the anterior and posterior vagina wall and the sacrum.

The clinical outcomes measured were symptoms of prolapse, obstructive defecation syndrome and quality of life. Radiological outcomes were distance of the vaginal vault below pubococcigeal line and depth of rectovaginal wall protrusion in dynamic pelvic resonance.

Results

33 patients were included. 32 of them remained asymptomatic after a three years follow-up. Significant differences were shown in the obstructed defecation score and quality of life after 6, 12 and 36 months compared to preoperatively. No differences were identified when the postoperative results were compared.

Significant differences were shown in preoperative vaginal vault prolapse (3.2 cms ± 0.8 SD below the pubococcigeal Line) and rectocele size, compared with 1 and 3 years after surgery. There were no significant differences in vaginal vault prolapse when compared after 1 and 3 years.

When rectocele size after 1 and 3 years was compared, significant differences were shown, but only one clinical recurrence (3%) was identified after a mean follow-up of 47 months.

Conclusions

Laparoscopic sacrocolpoperineopexy in patients with symptomatic rectocele and III/IV vaginal vault prolapse solves the constipation and obstructed defecation with an excellent quality of life and low clinical recurrences. Radiological deterioration, especially in rectocele size, was identified in the mid-term follow-up without clinical significance.

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Authors and Affiliations

  1. Biliopancreatic Surgical Division, Virgen de La Macarena Hospital, Seville University, Seville, Spain

    Juan Bellido Luque

  2. Surgical Department, QuirónSalud Sagrado Corazón Hospital, Seville, Spain

    Juan Bellido Luque

  3. Ginecological Department, Minas de Riotinto Hospital, Av. de la Esquila, 5, Minas de Riotinto, 21660, Huelva, Spain

    Juan Limón Padilla & Elena Pascual Salvador

  4. Gastrointestinal Surgical Department, Minas de Riotinto Hospital, Av. de la Esquila, 5, Minas de Riotinto, 21660, Huelva, Spain

    Joaquín García Moreno, Julio Gomez Menchero & Juan Manuel Suarez Grau

  5. Gastrointestinal Surgical Department, Infanta Elena Hospital, ctra. Sevilla-Huelva s/n, 21080, Huelva, Spain

    Juan Guadalajara Jurado

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  1. Juan Bellido Luque
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Correspondence to Juan Bellido Luque.

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Disclosures

Drs Bellido luque, Juan; Limón Padilla, Juan; García Moreno, Joaquin, Gomez Menchero, Julio; Suarez Grau, Juan Manuel; Guadalajara Jurado, Juan, have no conflicts of interest or financial ties to disclosure.

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Bellido Luque, J., Limón Padilla, J., García Moreno, J. et al. Three years prospective clinical and radiologic follow-up of laparoscopic sacrocolpoperineopexy. Surg Endosc 35, 5980–5990 (2021). https://doi.org/10.1007/s00464-020-08083-5

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  • DOI: https://doi.org/10.1007/s00464-020-08083-5

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