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Troubles anorectaux après chirurgie du prolapsus génital

Anorectal disorders following pelvic organ prolapse surgery

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Pelvi-périnéologie

Résumé

Les troubles du transit (constipation) et de la défécation (dyschésie) sont des symptômes assez fréquemment rapportés chez les femmes qui consultent pour un prolapsus génital. Toutefois, il existe très peu de données sur la prévalence des troubles anorectaux survenant de novo après une chirurgie pour prolapsus génital. L’évaluation comporte un interrogatoire et un examen clinique complet, ainsi que des explorations physiologiques comme la manométrie anorectale, le test d’expulsion au ballonnet, la défécographie et l’IRM pelvienne. Une constipation de novo est rapportée par des femmes opérées (jusqu’à 26 %) d’une promontofixation par laparotomie, et cette prévalence varie de 5 à 19 % chez les femmes opérées d’une promontofixation coelioscopique. La prévalence de la dyschésie de novo varie de 2 à 4 % chez les femmes pérées soit par promontofixation coelioscopique, soit par voie vaginale avec mise en place d’une prothèse synthétique en polypropylène. Au total, la survenue de novo de troubles anorectaux après chirurgie du prolapsus n’est pas une situation si exceptionnelle, et les patientes doivent en être informées avant l’intervention.

Abstract

Functional disorders of defecation (constipation, obstructive defecation syndrome, faucal incontinence) are common in women presenting with pelvic organ prolapse. However, very few data are available concerning de novo anorectal disorders following pelvic organ prolapse surgery. Evaluation includes detailed history and rectal and pelvic exam, together with physiologic tests such as anorectal manometry, balloon expulsion test, defecography, and pelvic MRI. De novo constipation is reported up to 26% in women who have undergone abdominal sacrocolpopexy and ranges from 5% to 19% in women who have undergone a laparoscopic sacrocolpopexy. The prevalence of de novo obstructed defecation syndrome ranges from 2% to 4% in women who have undergone laparoscopic sacrocolpopexy or for whom a synthetic polypropylene mesh was placed by vaginal route. Finally, the prevalence of de novo anorectal disorders is not rare following pelvic organ prolapse surgery and patients should be informed preoperatively.

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Authors and Affiliations

  1. Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Antoine-Béclère, Assistance publique-Hôpitaux de Paris (AP-HP), université Paris-Sud, 157, rue de la Porte-de-Trivaux, F-92141, Clamart, France

    X. Deffieux, T. Thubert, C. Trichot, A.-C. Donnadieu & E. Faivre

  2. UPMC université Paris-VI, ER 6, F-75005, Paris, France

    X. Deffieux

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  1. X. Deffieux
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  2. T. Thubert
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  4. A.-C. Donnadieu
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  5. E. Faivre
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Correspondence to X. Deffieux.

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Deffieux, X., Thubert, T., Trichot, C. et al. Troubles anorectaux après chirurgie du prolapsus génital. Pelv Perineol 5, 185–189 (2010). https://doi.org/10.1007/s11608-010-0322-1

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  • DOI: https://doi.org/10.1007/s11608-010-0322-1

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