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Combined rectopexy and sacrocolpopexy is safe for correction of pelvic organ prolapse

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Pelvic floor abnormalities often affect multiple organs. The incidence of concomitant uterine/vaginal prolapse with rectal prolapse is at least 38%. For these patients, addition of sacrocolpopexy to rectopexy may be appropriate. Our aim was to determine if addition of sacrocolpopexy to rectopexy increases the procedural morbidity over rectopexy alone.

Methods

We utilized the ACS-NSQIP database to examine female patients who underwent rectopexy from 2005 to 2014. We compared patients who had a combined procedure (sacrocolpopexy and rectopexy) to those who had rectopexy alone. Thirty-day morbidity was compared and a multivariable model constructed to determine predictors of complications.

Results

Three thousand six hundred patients underwent rectopexy; 3394 had rectopexy alone while 206 underwent a combined procedure with the addition of sacrocolpopexy. Use of the combined procedure increased significantly from 2.6 to 7.7%. Overall morbidity did not differ between groups (14.8% rectopexy alone vs. 13.6% combined procedure, p = 0.65). Significant predictors of morbidity included addition of resection to a rectopexy procedure, elevated BMI, smoking, wound class, and ASA class. After controlling for these and other patient factors, the addition of sacrocolpopexy to rectopexy did not increase overall morbidity (OR 1.00, p = 0.98).

Conclusions

There is no difference in operative morbidity when adding sacrocolpopexy to a rectopexy procedure. Despite a modest increase in utilization of combined procedures over time, the overall rate remains low. These findings support the practice of multidisciplinary evaluation of patients presenting with rectal prolapse, with the goal of offering concurrent surgical correction for all compartments affected by pelvic organ prolapse disorders.

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Authors and Affiliations

  1. Department of Surgery, Division of Colon and Rectal Surgery, University of Wisconsin School of Medicine and Public Health, University of Wisconsin Hospital and Clinics, K3/704 Clinical Science Center, 600 Highland Avenue, Madison, WI, 53792-7375, USA

    Cristina B. Geltzeiler

  2. Department of Surgery, Division of Colon and Rectal Surgery, University of Colorado School of Medicine, Aurora, CO, USA

    Elisa H. Birnbaum

  3. Section of Colon and Rectal Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA

    Matthew L. Silviera

  4. Division of Urology, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA

    Matthew G. Mutch, Joel Vetter, Paul E. Wise, Steven R. Hunt & Sean C. Glasgow

Authors
  1. Cristina B. Geltzeiler
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  2. Elisa H. Birnbaum
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  3. Matthew L. Silviera
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  4. Matthew G. Mutch
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  5. Joel Vetter
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  6. Paul E. Wise
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  7. Steven R. Hunt
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  8. Sean C. Glasgow
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Contributions

All authors have participated in the conception and design, acquisition, analysis and interpretation of data, and the drafting and revision of this article. All authors have approved the final version of this manuscript to be published.

Corresponding author

Correspondence to Cristina B. Geltzeiler.

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Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Presentation: This work was presented as a poster presentation at the American Society of Colon and Rectal Surgeons 2017 Annual Meeting, June 10–14, Seattle, WA.

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Geltzeiler, C.B., Birnbaum, E.H., Silviera, M.L. et al. Combined rectopexy and sacrocolpopexy is safe for correction of pelvic organ prolapse. Int J Colorectal Dis 33, 1453–1459 (2018). https://doi.org/10.1007/s00384-018-3140-5

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  • DOI: https://doi.org/10.1007/s00384-018-3140-5

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