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Drissi F, Rogier-Mouzelas F, Fernandez Arias S, Podevin J, Meurette G. Moving from Laparoscopic Synthetic Mesh to Robotic Biological Mesh for Ventral Rectopexy: Results from a Case Series. J Clin Med 2023; 12:5751. [PMID: 37685818 PMCID: PMC10488879 DOI: 10.3390/jcm12175751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/25/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
Introduction: Laparoscopic ventral mesh rectopexy (VMR) is the standard procedure for the treatment of posterior pelvic organ prolapse. Despite significant functional improvement and anatomical corrections, severe complications related to mesh augmentation can occur in a few proportions of patients. In order to decrease the number of rare but severe complications, we developed a variant of the conventional VMR without any rectal fixation and using a robotic approach with biological mesh. The aim of this study was to compare the results of laparoscopic ventral rectopexy with synthetic mesh (LVMRS) to those of robotic ventral rectopexy with biological mesh (RVMRB). Methods: Between 2004 and 2021, patients operated on for VMR in our unit were identified and separated into two groups: LVMRS and RVMRB. The surgical technique for both groups consisted of VMR without any rectal fixation, with mesh distally secured on the levator ani muscles. Results: 269 patients with a mean age of 62 years were operated for posterior pelvic floor disorder: rectocele (61.7%) and external rectal prolapse (34.6%). 222 (82.5%) patients received LVMRS (2004-2015), whereas 47 were operated with RVMRB (2015-2021). Both groups slightly differed for combined anterior fixation proportion (LVMRS 39% vs. RVMRB 6.4%, p < 0.001). Despite these differences, the length of stay was shorter in the RVMRB group (2 vs. 3 days, p < 0.001). Postoperative complications were comparable in the two groups (1.8 vs. 4.3%, p = 0.089) and mainly consisted of minor complications. Functional outcomes were favorable and similar in both groups, with an improvement in bulging, obstructed defecation symptoms, and fecal incontinence (NS in subgroup analysis). In the long term, there were no mesh erosions reported. The overall recurrence rate was 11.9%, and was comparable in the two groups (13% LVMRS vs. 8.5, p = 0.43). Conclusions: VMR without rectal fixation is a safe and effective approach in posterior organ prolapse management. RVMRB provides comparable results in terms of recurrence and functional results, with avoidance of unabsorbable material implantation.
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Affiliation(s)
- Farouk Drissi
- Department of Digestive Surgery, University Hospital of Nantes, 1 Place Alexis Ricordeau, 44093 Nantes, France
| | - Fabien Rogier-Mouzelas
- Department of Digestive Surgery, University Hospital of Nantes, 1 Place Alexis Ricordeau, 44093 Nantes, France
| | | | - Juliette Podevin
- Department of Digestive Surgery, University Hospital of Nantes, 1 Place Alexis Ricordeau, 44093 Nantes, France
| | - Guillaume Meurette
- Division of Digestive Surgery, University Hospitals of Geneva, 1211 Geneva, Switzerland;
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Campagna G, Panico G, Vacca L, Caramazza D, Mastrovito S, Lombisani A, Ercoli A, Scambia G. Robotic sacrocolpopexy plus ventral rectopexy as combined treatment for multicompartment pelvic organ prolapse using the new Hugo RAS system. Tech Coloproctol 2023; 27:499-500. [PMID: 36786846 DOI: 10.1007/s10151-023-02768-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 02/01/2023] [Indexed: 02/15/2023]
Affiliation(s)
- G Campagna
- Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, UOC Chirurgia Ginecologica, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - G Panico
- Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, UOC Chirurgia Ginecologica, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - L Vacca
- Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, UOC Chirurgia Ginecologica, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - D Caramazza
- Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, UOC Chirurgia Ginecologica, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - S Mastrovito
- Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, UOC Chirurgia Ginecologica, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - A Lombisani
- Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, UOC Chirurgia Ginecologica, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - A Ercoli
- Ginecologia Oncologica e Chirurgia Ginecologica Miniinvasiva, Università degli studi di Messina, Policlinico G. Martino, Messina, Italy
| | - G Scambia
- Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, UOC Chirurgia Ginecologica, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Kalev G, Marquardt C, Schmerer M, Ulrich A, Heyl W, Schiedeck T. Resection rectopexy as part of the multidisciplinary approach in the management of complex pelvic floor disorders. Innov Surg Sci 2023; 8:29-36. [PMID: 37842195 PMCID: PMC10576551 DOI: 10.1515/iss-2022-0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 05/22/2023] [Indexed: 10/17/2023] Open
Abstract
Objectives Pelvic floor disorders are frequently caused by an organ prolapse involving multiple pelvic floor compartments. In such cases, a multidisciplinary strategy for diagnostic work-up and therapy is required. Methods All patients who underwent transabdominal rectopexy/resection rectopexy alone or in combination with simultaneous gynecological pelvic floor reconstruction at our institution between 01/2006 and 12/2021 were included in this retrospective study. The study aimed to evaluate the functional outcome and postoperative complications. Results Two hundred and eighty seven patients were assigned to one of the following groups: PG1 - patient group one: after resection rectopexy (n=141); PG2 - after ventral rectopexy (n=8); PG3 - after combined resection rectopexy and sacro (cervico)colpopexy (n=62); PG4 - after combined resection rectopexy and trans-vaginal pelvic floor repair (n=76). The duration of follow-up was 14 months for PG1 (median, IQR 37 months), 11 months for PG2 (mean, SD 9 months), 7 months for PG 3 (median, IQR 33 months), and 12 months for PG 4 (median, IQR 51 Months). The surgical procedure resulted in improvement of symptoms related to obstructed defecation in 56.4 % (22/39) of the patients in PG1, 25 % in PG2 (1/4), 62.5 % (20/32) in PG3, and 71.8 % (28/39) in PG4. "De novo" constipation was reported by 2.4 % (2/141) of patients from PG1. Improvement in fecal incontinence symptoms was reported by 69 % (40/58) of patients in PG1, 100 % in PG2 (2/2), 93.1 % (27/29) in PG3, and 87.2 % (34/39) in PG4. The recurrence rate for external rectal prolapse was 7.1 % in PG1, 50 % in PG2 (1/2), 2.7 % in PG3, and 6.3 % in PG4. A significant difference in terms of severe morbidity (grade ≥ IIIb) and mortality could not be determined between the non-interdisciplinary (PG1 with PG2) and interdisciplinary surgery (PG3 with PG4) (p=0.88, p=0.499). Conclusions Based on our results, we can assume that combined surgery is as feasible as rectal surgery alone. In our study, combined interventions were effective and not associated with an increased risk of postoperative complications.
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Affiliation(s)
- Georgi Kalev
- Department of General, Visceral, Thoracic and Pediatric Surgery, Ludwigsburg Hospital, Ludwigsburg, Germany
| | - Christoph Marquardt
- Department of General, Visceral, Thoracic and Pediatric Surgery, Ludwigsburg Hospital, Ludwigsburg, Germany
| | - Marten Schmerer
- Department of General, Visceral, Thoracic and Pediatric Surgery, Ludwigsburg Hospital, Ludwigsburg, Germany
| | - Anja Ulrich
- Department of General, Visceral, Thoracic and Pediatric Surgery, Ludwigsburg Hospital, Ludwigsburg, Germany
| | - Wolfgang Heyl
- Department of Obstetrics and Gynecology, Ludwigsburg Hospital, Ludwigsburg, Germany
| | - Thomas Schiedeck
- Department of General, Visceral, Thoracic and Pediatric Surgery, Ludwigsburg Hospital, Ludwigsburg, Germany
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Haouari MA, Boulay-Coletta I, Khatri G, Touloupas C, Anglaret S, Tardivel AM, Beranger-Gibert S, Silvera S, Loriau J, Zins M. Complications of Mesh Sacrocolpopexy and Rectopexy: Imaging Review. Radiographics 2023; 43:e220137. [PMID: 36701247 DOI: 10.1148/rg.220137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Sacrocolpopexy and rectopexy are commonly used surgical options for treatment of patients with pelvic organ and rectal prolapse, respectively. These procedures involve surgical fixation of the vaginal vault or the rectum to the sacral promontory with mesh material and can be performed independently of each other or in a combined fashion and by using an open abdominal approach or laparoscopy with or without robotic assistance. Radiologists can be particularly helpful in cases where patients' surgical histories are unclear by identifying normal sacrocolpopexy or rectopexy mesh material and any associated complications. Acute complications such as bleeding or urinary tract injury or stricture are generally evaluated with CT. More chronic complications such as mesh extrusion or exposure with or without fistulization to surrounding structures are generally evaluated with MRI. Other complications can have a variable time of onset after surgery. Patients with suspected bowel obstruction are generally evaluated with CT. Those with suspected infection, abscess formation, and discitis or osteomyelitis may be evaluated with MRI, although CT evaluation may be appropriate in certain scenarios. The authors review the sacrocolpopexy and rectopexy surgical techniques, discuss appropriate imaging protocols for evaluation of patients with suspected complications, and illustrate the normal appearance and common complications of these procedures. © RSNA, 2023 Quiz questions for this article are available in the supplemental material.
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Affiliation(s)
- Mohamed Amine Haouari
- From the Departments of Radiology (M.A.H., I.B.C., C.T., S.A., A.M.T., S.B.G., S.S., M.Z.) and Digestive Surgery (J.L.), Groupe Hospitalier Paris Saint-Joseph, 185 Rue Raymond Losserand, 74014 Paris, France; and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.K.)
| | - Isabelle Boulay-Coletta
- From the Departments of Radiology (M.A.H., I.B.C., C.T., S.A., A.M.T., S.B.G., S.S., M.Z.) and Digestive Surgery (J.L.), Groupe Hospitalier Paris Saint-Joseph, 185 Rue Raymond Losserand, 74014 Paris, France; and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.K.)
| | - Gaurav Khatri
- From the Departments of Radiology (M.A.H., I.B.C., C.T., S.A., A.M.T., S.B.G., S.S., M.Z.) and Digestive Surgery (J.L.), Groupe Hospitalier Paris Saint-Joseph, 185 Rue Raymond Losserand, 74014 Paris, France; and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.K.)
| | - Caroline Touloupas
- From the Departments of Radiology (M.A.H., I.B.C., C.T., S.A., A.M.T., S.B.G., S.S., M.Z.) and Digestive Surgery (J.L.), Groupe Hospitalier Paris Saint-Joseph, 185 Rue Raymond Losserand, 74014 Paris, France; and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.K.)
| | - Sophie Anglaret
- From the Departments of Radiology (M.A.H., I.B.C., C.T., S.A., A.M.T., S.B.G., S.S., M.Z.) and Digestive Surgery (J.L.), Groupe Hospitalier Paris Saint-Joseph, 185 Rue Raymond Losserand, 74014 Paris, France; and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.K.)
| | - Anne-Marie Tardivel
- From the Departments of Radiology (M.A.H., I.B.C., C.T., S.A., A.M.T., S.B.G., S.S., M.Z.) and Digestive Surgery (J.L.), Groupe Hospitalier Paris Saint-Joseph, 185 Rue Raymond Losserand, 74014 Paris, France; and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.K.)
| | - Sophie Beranger-Gibert
- From the Departments of Radiology (M.A.H., I.B.C., C.T., S.A., A.M.T., S.B.G., S.S., M.Z.) and Digestive Surgery (J.L.), Groupe Hospitalier Paris Saint-Joseph, 185 Rue Raymond Losserand, 74014 Paris, France; and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.K.)
| | - Stephane Silvera
- From the Departments of Radiology (M.A.H., I.B.C., C.T., S.A., A.M.T., S.B.G., S.S., M.Z.) and Digestive Surgery (J.L.), Groupe Hospitalier Paris Saint-Joseph, 185 Rue Raymond Losserand, 74014 Paris, France; and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.K.)
| | - Jerome Loriau
- From the Departments of Radiology (M.A.H., I.B.C., C.T., S.A., A.M.T., S.B.G., S.S., M.Z.) and Digestive Surgery (J.L.), Groupe Hospitalier Paris Saint-Joseph, 185 Rue Raymond Losserand, 74014 Paris, France; and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.K.)
| | - Marc Zins
- From the Departments of Radiology (M.A.H., I.B.C., C.T., S.A., A.M.T., S.B.G., S.S., M.Z.) and Digestive Surgery (J.L.), Groupe Hospitalier Paris Saint-Joseph, 185 Rue Raymond Losserand, 74014 Paris, France; and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.K.)
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Cianci S, Giovinazzo F, Campagna G, Ercoli A. Editorial: Challenges, techniques and pitfalls in surgery: How far can we push the boundaries? Front Oncol 2022; 12:1088759. [PMID: 36561524 PMCID: PMC9763988 DOI: 10.3389/fonc.2022.1088759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 11/22/2022] [Indexed: 12/12/2022] Open
Affiliation(s)
- S. Cianci
- Department of Human Pathology of Adult and Childhood “G. Barresi” Unit of Gynecology and Obstetrics, University of Messina, Messina, Italy,*Correspondence: S. Cianci,
| | - F. Giovinazzo
- General Surgery and Liver Transplantation Unit, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - G. Campagna
- Department of Gynaecology and Obstetrics, Fondazione Policlinico Universitario “A. Gemelli”, Università Cattolica del Sacro Cuore, Roma, Italy
| | - A. Ercoli
- Department of Human Pathology of Adult and Childhood “G. Barresi” Unit of Gynecology and Obstetrics, University of Messina, Messina, Italy
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Thorsen AJ. Management of Rectocele with and without Obstructed Defecation. SEMINARS IN COLON AND RECTAL SURGERY 2022. [DOI: 10.1016/j.scrs.2022.100937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Morciano A, Caliandro D, Campagna G, Panico G, Giaquinto A, Fachechi G, Zullo MA, Tinelli A, Ercoli A, Scambia G, Cervigni M, Marzo G. Laparoscopic ventral rectopexy plus sacral colpopexy: continuous locked suture for mesh fixation. A randomized clinical trial. Arch Gynecol Obstet 2022; 306:1573-1579. [PMID: 35835920 DOI: 10.1007/s00404-022-06682-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 06/19/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Laparoscopic ventral rectopexy (LVR) plus sacral colpopexy (LSC) is a high-complexity surgical procedure. The aim of the present study was to evaluate a new approach to rectal-mesh fixation during LVR with continuous locked suture. METHODS This is a prospective randomized double-blinded clinical trial enrolling 80 patients with severe POP and obstructed defecation syndrome (ODS) from November 2016 to January 2021. Patients underwent a "two-meshes" LSC plus LVR and were randomized, regarding rectal mesh fixation, in Group A (extracorporeal interrupted 0 delayed absorbable sutures) and Group B ("U-shaped" running locked 0 delayed absorbable suture). Our primary endpoints were the operative times (OT); the secondary endpoints were the incidence of anatomical failures, vaginal mesh erosions and surgical complications. RESULTS A total of 75 patients completed the study. Baseline characteristics were similar between the groups. Overall OT (156 vs 138 min; p < 0.05; treatment reduction of 11.5%) and LVR mesh fixation time (29 vs 16 min; p < 0.05; treatment reduction of 44%), resulted in significantly lower in Group B. No differences were found in terms of anatomic failure, vaginal mesh erosion or intra- or post-operative complications. PGI-I, FSDS and Wexner questionnaires resulted significantly improved after surgery, without statistical differences between the studied surgical procedures. CONCLUSION Laparoscopic continuous locked 0 absorbable suture for LVR mesh fixation guaranteed a faster and effective alternative to multiple interrupted sutures. The significant OT reduction linked to this technique should be considered even more helpful when performing a highly complex surgery such as LVR. CLINICAL TRIAL REGISTRATION NCT05254860 (13/02/2017).
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Affiliation(s)
- Andrea Morciano
- Panico Pelvic Floor Center, Department of Gynaecology and Obstetrics, Pia Fondazione "Card. G. Panico", Tricase, Lecce, Italy. .,AIUG Research GroupAssociazione Italiana di UroGinecologia e del Pavimento Pelvico, Rome, Italy.
| | - Dario Caliandro
- Panico Pelvic Floor Center, Department of Gynaecology and Obstetrics, Pia Fondazione "Card. G. Panico", Tricase, Lecce, Italy.,AIUG Research GroupAssociazione Italiana di UroGinecologia e del Pavimento Pelvico, Rome, Italy
| | - Giuseppe Campagna
- Department of Gynaecology and Obstetrics, Fondazione Policlinico Universitario "A. Gemelli", Università Cattolica del Sacro Cuore, Rome, Italy.,AIUG Research GroupAssociazione Italiana di UroGinecologia e del Pavimento Pelvico, Rome, Italy
| | - Giovanni Panico
- Department of Gynaecology and Obstetrics, Fondazione Policlinico Universitario "A. Gemelli", Università Cattolica del Sacro Cuore, Rome, Italy.,AIUG Research GroupAssociazione Italiana di UroGinecologia e del Pavimento Pelvico, Rome, Italy
| | - Alessia Giaquinto
- Panico Pelvic Floor Center, Department of Gynaecology and Obstetrics, Pia Fondazione "Card. G. Panico", Tricase, Lecce, Italy
| | - Giorgio Fachechi
- Panico Pelvic Floor Center, Department of Gynaecology and Obstetrics, Pia Fondazione "Card. G. Panico", Tricase, Lecce, Italy
| | - Marzio Angelo Zullo
- Department of Surgery-Week Surgery, University "Campus Biomedico", Rome, Italy.,AIUG Research GroupAssociazione Italiana di UroGinecologia e del Pavimento Pelvico, Rome, Italy
| | - Andrea Tinelli
- Department of Gynaecology and Obstetrics, "Veris Delli Ponti Hospital", Scorrano, Lecce, Italy
| | - Alfredo Ercoli
- Department of Gynaecology and Obstetrics, Università Degli Studi Di Messina, Messina, Italy.,AIUG Research GroupAssociazione Italiana di UroGinecologia e del Pavimento Pelvico, Rome, Italy
| | - Giovanni Scambia
- Department of Gynaecology and Obstetrics, Fondazione Policlinico Universitario "A. Gemelli", Università Cattolica del Sacro Cuore, Rome, Italy
| | - Mauro Cervigni
- Department of Urology, ICOT, Università "La Sapienza", Latina, Italy.,AIUG Research GroupAssociazione Italiana di UroGinecologia e del Pavimento Pelvico, Rome, Italy
| | - Giuseppe Marzo
- Panico Pelvic Floor Center, Department of Gynaecology and Obstetrics, Pia Fondazione "Card. G. Panico", Tricase, Lecce, Italy
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Postoperative complications and pelvic organ prolapse recurrence following combined pelvic organ prolapse and rectal prolapse surgery compared with pelvic organ prolapse only surgery. Am J Obstet Gynecol 2022; 227:317.e1-317.e12. [PMID: 35654113 DOI: 10.1016/j.ajog.2022.05.050] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 05/20/2022] [Accepted: 05/24/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND There is a growing interest in combined pelvic organ prolapse and rectal prolapse surgery for concomitant pelvic floor prolapse despite a paucity of data regarding complications and clinical outcomes of combined repair. OBJECTIVE The primary objective of this study was to compare the <30-day postoperative complication rate in women undergoing combined POP + RP surgery with that of women undergoing pelvic organ prolapse-only surgery. The secondary objectives were to describe the <30-day postoperative complications, compare the pelvic organ prolapse recurrence between the 2 groups, and determine the preoperative predictors of <30-day postoperative complications and predictors of pelvic organ prolapse recurrence. STUDY DESIGN This was a multicenter, retrospective cohort study at 5 academic hospitals. Patients undergoing combined pelvic organ prolapse and rectal prolapse surgery were matched by age, pelvic organ prolapse stage by leading compartment, and pelvic organ prolapse procedure compared with those undergoing pelvic organ prolapse-only surgery from March 2003 to March 2020. The primary outcome measure was <30-day complications separated into Clavien-Dindo classes. The secondary outcome measures were (1) subsequent pelvic organ prolapse surgeries and (2) pelvic organ prolapse recurrence, defined as patients who complained of vaginal bulge symptoms postoperatively. RESULTS Overall, 204 women underwent combined surgery for pelvic organ prolapse and rectal prolapse, and 204 women underwent surgery for pelvic organ prolapse only. The average age (59.3±1.0 vs 59.0±1.0) and mean parity (2.3±1.5 vs 2.6±1.8) were similar in each group. Of note, 109 (26.7%) patients had at least one <30-day postoperative complication. The proportion of patients who had a complication in the combined surgery group and pelvic organ prolapse-only surgery group was similar (27.5% vs 26.0%; P=.82). The Clavien-Dindo scores were similar between the groups (grade I, 10.3% vs 9.3%; grade II, 11.8% vs 12.3%; grade III, 3.9% vs 4.4%; grade IV, 1.0% vs 0%; grade V, 0.5% vs 0%). Patients undergoing combined surgery were less likely to develop postoperative urinary tract infections and urinary retention but were more likely to be treated for wound infections and pelvic abscesses than patients undergoing pelvic organ prolapse-only surgery. After adjusting for combined surgery vs pelvic organ prolapse-only surgery and parity, patients who had anti-incontinence procedures (adjusted odds ratio, 1.85; 95% confidence interval, 1.16-2.94; P=.02) and perineorrhaphies (adjusted odds ratio, 1.68; 95% confidence interval, 1.05-2.70; P=.02) were more likely to have <30-day postoperative complications. Of note, 12 patients in the combined surgery group and 15 patients in the pelvic organ prolapse-only surgery group had subsequent pelvic organ prolapse repairs (5.9% vs 7.4%; P=.26). In the combined surgery group, 10 patients (4.9%) underwent 1 repair, and 2 patients (1.0%) underwent 2 repairs. All patients who had recurrent pelvic organ prolapse surgery in the pelvic organ prolapse-only surgery group had 1 subsequent pelvic organ prolapse repair. Of note, 21 patients in the combined surgery group and 28 patients in the pelvic organ prolapse-only surgery group reported recurrent pelvic organ prolapse (10.3% vs 13.7%; P=.26). On multivariable analysis adjusted for number of previous pelvic organ prolapse repairs, combined surgery vs pelvic organ prolapse-only surgery, and perineorrhaphy at the time of surgery, patients were more likely to have a subsequent pelvic organ prolapse surgery if they had had ≥2 previous pelvic organ prolapse repairs (adjusted odds ratio, 6.06; 95% confidence interval, 2.10-17.5; P=.01). The average follow-up times were 307.2±31.5 days for the combined surgery cohort and 487.7±49.9 days for the pelvic organ prolapse-only surgery cohort. Survival curves indicated that the median time to recurrence was not statistically significant (log-rank, P=.265) between the combined surgery group (4.2±0.4 years) and the pelvic organ prolapse-only surgery group (5.6±0.4 years). CONCLUSION In this retrospective cohort study, patients undergoing combined pelvic organ prolapse and rectal prolapse surgery had a similar risk of <30-day postoperative complications compared with patients undergoing pelvic organ prolapse-only surgery. Furthermore, patients who underwent combined surgery had a similar risk of recurrent pelvic organ prolapse and subsequent pelvic organ prolapse surgery compared with patients who underwent pelvic organ prolapse-only surgery.
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Contemporary Use and Techniques of Laparoscopic Sacrocolpopexy With or Without Robotic Assistance for Pelvic Organ Prolapse. Obstet Gynecol 2022; 139:922-932. [PMID: 35576354 PMCID: PMC9015033 DOI: 10.1097/aog.0000000000004761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 12/30/2021] [Indexed: 11/30/2022]
Abstract
Laparoscopic sacrocolpopexy with or without robotic assistance is an effective approach for the treatment of any pelvic organ prolapse when apical involvement is present. The past 4 years have been consequential in the world of surgery to correct pelvic organ prolapse. In 2018, results of a large, multicenter randomized trial demonstrated very disappointing cure rates of traditional native tissue repairs at 5 years or more. In 2019, a vaginal mesh hysteropexy kit was removed from the market by the U.S. Food and Drug Administration only to subsequently demonstrate it provided better cure rates and similar risk profile to vaginal hysterectomy plus native tissue repair in its own 5-year study published in 2021. Meanwhile, the use and techniques of laparoscopic sacrocolpopexy with or without robotic assistance have evolved such that it is commonly adapted to treat all support defects for patients with uterovaginal or posthysterectomy prolapse. This article is intended to provide an overview of the contemporary use and techniques of laparoscopic sacrocolpopexy based on the evidence and our clinical experience.
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Abstract
Combined rectal prolapse and pelvic organ prolapse surgery provides significant quality-of-life benefits with improvements in bothersome symptoms of pain, bulge, constipation, urinary retention, as well as bowel and bladder incontinence. Robotic surgery is the ideal tool for a combined surgical repair. It allows enhanced suturing in the deep pelvis, three-dimensional (3D) visualization of the presacral space and easy mobilization of the rectum and dissection of the vagina. Combined procedures can be offered to patients with the advantages of a single operation and concurrent recovery period without increasing complications. In this article, we highlight our approach to combined prolapse repair.
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Affiliation(s)
- Shannon Wallace
- Urogynecology/Department of Obstetrics and Gynecology, Female Pelvic Medicine and Reconstructive Surgery (Urogynecology), Women's Health Institute, Cleveland, Ohio
| | - Brooke Gurland
- Urogynecology/Department of Obstetrics and Gynecology, Female Pelvic Medicine and Reconstructive Surgery (Urogynecology), Women's Health Institute, Cleveland, Ohio,Department of Surgery, Stanford Pelvic Health Center, Stanford University, Stanford, California,Address for correspondence Brooke Gurland, MD, FACS, FASCRS Department of Surgery, Stanford Pelvic Health Center, Stanford University300 Pasteur Drive, Stanford, CA 94305
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Campagna G, Vacca L, Caramazza D, Panico G, Mastrovito S, Scambia G, Ercoli A. Laparoscopic sacral hysteropexy for pelvic organ prolapse in a patient affected by marfan syndrome: a case report. Facts Views Vis Obgyn 2021; 13:399-403. [PMID: 35026102 PMCID: PMC9148703 DOI: 10.52054/fvvo.13.4.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Marfan Syndrome (MS) is a dominantly inherited connective tissue disorder with consequences on the strength and resilience of connective tissues that may predispose to Pelvic Organ Prolapse (POP). Literature lacks studies investigating POP surgery in patients affected by MS that might help surgical management decisions.
Objective: The objective of this paper is to describe the surgical procedure of laparoscopic sacral hysteropexy (LSHP) in a 37 years old woman affected by MS with symptomatic POP.
Materials and Methods and main outcome measures: We performed a nerve-sparing laparoscopic sacral hysteropexy without complications and looked for anatomical and subjective outcomes. The patient completed The Female Sexual Distress Scale (FSDS), Pelvic Floor Disability Index (PFDI-20), and Wexner questionnaires preoperatively and postoperatively.
Results: The patient stated a complete resolution of all POP related symptoms and there was a total correction of the descensus. Furthermore, no perioperative and postoperative complications were noted.
Conclusions: LSHP could be an effective and safe procedure for the treatment of POP in women affected by MS and this case report is the first to describe a reconstructive procedure in this category of patients.
What is new? The literature lacks studies investigating POP surgery in women with MS, that might help surgeons, thus we present this case to describe surgical and functional outcomes in this patient category, underlying the higher risk of complications and relapses related to the weakness of connective tissue. This case report may represent the basis of future studies to confirm the safety, efficacy and feasibility of LSHP and sacral colpopexy in patients with MS.
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Zigiotto D, Sturiale A, Fabiani B, Fralleone L, Simoncini T, Naldini G. Robotic supracervical hysterectomy and colpo-procto-sacropexy with folded titanized polypropylene mesh for multicompartmental pelvic organ prolapse - a video-vignette. Colorectal Dis 2021; 23:2783. [PMID: 34260127 DOI: 10.1111/codi.15810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 07/01/2021] [Accepted: 07/01/2021] [Indexed: 02/08/2023]
Affiliation(s)
- Daniele Zigiotto
- Proctological and Perineal Surgical Unit, Ospedale Civile Maggiore, University of Verona, Verona, Italy
| | - Alessandro Sturiale
- Proctological and Perineal Surgical Unit, Cisanello University Hospital, Pisa, Italy
| | - Bernardina Fabiani
- Proctological and Perineal Surgical Unit, Cisanello University Hospital, Pisa, Italy
| | - Lisa Fralleone
- Proctological and Perineal Surgical Unit, Cisanello University Hospital, Pisa, Italy
| | - Tommaso Simoncini
- Proctological and Perineal Surgical Unit, Cisanello University Hospital, Pisa, Italy
| | - Gabriele Naldini
- Proctological and Perineal Surgical Unit, Cisanello University Hospital, Pisa, Italy
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Baracy Jr MG, Richardsona C, Mackeya KR, Hagglund KH, Aslam MF. Does ventral mesh rectopexy at the time of sacrocolpopexy prevent subsequent posterior wall prolapse? J Turk Ger Gynecol Assoc 2021; 22:174-180. [PMID: 34109716 PMCID: PMC8420747 DOI: 10.4274/jtgga.galenos.2021.2021.0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective: To determine whether ventral mesh rectopexy at the time of sacrocolpopexy reduces the rate of future posterior wall prolapse. Material and Methods: This was a retrospective cohort study of women with pelvic organ prolapse (POP) who underwent sacrocolpopexy or without concomitant rectopexy at a single community hospital from December 1, 2015 to June 30, 2019. Preoperative pelvic organ prolapse quantification (POP-Q) and urodynamic testing was used in evaluation of POP. Patients were followed for 12-weeks postoperatively and a 12-week postoperative POP-Q assessment was completed. The incidence of new or recurrent posterior prolapse was compared between cohorts. Results: Women with POP (n=150) were recruited, of whom 41 (27.3%) underwent sacrocolpopexy while the remainder (n=109, 72.7%) did not receive rectopexy. Patient demographics did not statistically differ between cohorts. Post-surgical posterior wall prolapse was reduced in the robotic assisted sacrocolpopexy (RASC) + rectopexy group compared to RASC alone, however this did not reach statistical significance. There were no patients who underwent concomitant rectopexy and RASC that needed recurrent posterior wall prolapse surgery, compared to eight-percent of patients that underwent isolated RASC procedures. Conclusion: Our findings suggest a reduction in the need for subsequent posterior wall surgery when rectopexy is performed at the time of sacrocolpopexy. In our study, no future surgery for POP was found in the concomitant sacrocolpopexy and rectopexy group, while a small proportion of the RASC only group required future POP surgery. Our study, however, was underpowered to elucidate a statistically significant difference between groups. Future larger studies are needed to confirm a reduced risk of posterior wall prolapse in patients who undergo concomitant RASC and rectopexy.
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Affiliation(s)
- Michael G. Baracy Jr
- Department of Obstetrics and Gynecology, Ascension St. John Hospital, Michigan, United States of America
| | - Casey Richardsona
- Department of Obstetrics and Gynecology, Ascension St. John Hospital, Michigan, United States of America
| | - Kyle R. Mackeya
- Department of Obstetrics and Gynecology, Ascension St. John Hospital, Michigan, United States of America
| | - Karen H. Hagglund
- Department Biomedical Investigations and Research, Ascension St. John Hospital, Michigan, United States of America
| | - Muhammad Faisal Aslam
- Department of Female Pelvic Medicine and Reconstructive Surgery, Ascension St. John Hospital, Michigan, United States of America,Department of Female Pelvic Medicine and Reconstructive Surgery, Michigan State University, Michigan, United States of America
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Wallace SL, Enemchukwu EA, Mishra K, Neshatian L, Chen B, Rogo-Gupta L, Sokol ER, Gurland BH. Postoperative complications and recurrence rates after rectal prolapse surgery versus combined rectal prolapse and pelvic organ prolapse surgery. Int Urogynecol J 2021; 32:2401-2411. [PMID: 33864476 DOI: 10.1007/s00192-021-04778-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/24/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Our primary objectives were to compare < 30-day postoperative complications and RP recurrence rates after RP-only surgery and combined surgery. Our secondary objectives were to determine preoperative predictors of < 30-day complications and RP recurrence. METHODS A prospective IRB-approved cohort study was performed at a single tertiary care center from 2017 to 2020. Female patients with symptomatic RP underwent either RP-only surgery or combined surgery based on the discretion of the colorectal and FPMRS surgeons. Primary outcome measures were < 30-day complications separated into Clavien-Dindo (CD) classes and rectal prolapse on physical examination. RESULTS Seventy women had RP-only surgery and 45 had combined surgery with a mean follow-up time of 208 days. Sixty-eight percent underwent abdominal RP repair, and 32% underwent perineal RP repair. Twenty percent had one or more complications, 14% in the RP-only group and 29% in the combined surgery group (p = 0.06). On multivariate analysis, combined surgery patients had a 30% increased risk of complications compared to RP-only surgery patients (RR = 1.3). Most of these complications were minor (14/17, 82.4%) and categorized as CD I or II, including urinary retention and UTI. Twelve percent of this cohort had RP recurrence, 11% in the RP-only group and 13% in the combined surgery group (p = 0.76). Preoperative risk factors for RP recurrence included a primary complaint of rectal bleeding (RR 5.5) and reporting stools consistent with Bristol Stool Scale of 1 (RR 2.1). CONCLUSION Patients undergoing combined RP + POP surgery had a higher risk of complications and equivalent RP recurrence rates compared to patients undergoing RP-only surgery.
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Affiliation(s)
- Shannon L Wallace
- Women's Health Institute, Division of Urogynecology and Pelvic Floor Disorders, Cleveland Clinic Foundation, 9500 Euclid Avenue, Mailcode A81, Cleveland, OH, 44195, USA.
| | - Ekene A Enemchukwu
- Department of Urology, Division of Female Urology, Stanford University School of Medicine, Stanford, CA, USA
| | - Kavita Mishra
- Women's Health Institute, Division of Urogynecology and Pelvic Floor Disorders, Cleveland Clinic Foundation, 9500 Euclid Avenue, Mailcode A81, Cleveland, OH, 44195, USA
| | - Leila Neshatian
- Department of Gastroenterology, Stanford University School of Medicine, Stanford, CA, USA
| | - Bertha Chen
- Department of Obstetrics and Gynecology, Division of Urogynecology and Pelvic Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Lisa Rogo-Gupta
- Department of Obstetrics and Gynecology, Division of Urogynecology and Pelvic Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Eric R Sokol
- Department of Obstetrics and Gynecology, Division of Urogynecology and Pelvic Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Brooke H Gurland
- Department of Surgery, Division of Colorectal Surgery, Stanford University School of Medicine, Stanford, CA, USA
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Toda K, Aoyama T, Hirai K, Uemura T, Fujita H, Okabe A, Ohe H, Tachibana T, Mitsuyoshi A. Laparoscopic approach to recurrence following multiple surgeries for external rectal prolapse: a case report. Surg Case Rep 2021; 7:71. [PMID: 33742270 PMCID: PMC7979842 DOI: 10.1186/s40792-021-01154-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 03/10/2021] [Indexed: 12/03/2022] Open
Abstract
Introduction The optimal procedure for recurrent external rectal prolapse remains unclear, particularly in laparoscopic approach. In addition, pelvic organ prolapse (POP) is sometimes concomitant with rectal prolapse. We present a case who underwent laparoscopic procedure for the recurrence of full-thickness external rectal prolapse coexisting POP. Case presentation An 81-year-old parous female had a 10-cm full-thickness external rectal prolapse following the two operations: the first was perineal recto-sigmoidectomy and the second was laparoscopic posterior mesh rectopexy. Imaging study revealed that the recurrent rectal prolapse was concomitant with both cystocele and exposed vagina, what we call POP. We planned and successfully performed laparoscopic ventral mesh rectopexy (LVMR) with laparoscopic sacrocolpopexy (LSC) using self-cut meshes without any perioperative complication. Conclusion This is the first report of LVMR and LSC for recurrent rectal prolapse with POP following the perineal recto-sigmoidectomy and laparoscopic posterior mesh rectopexy. Even for recurrent rectal prolapse with POP, our experience suggests that LVMR and LSC could be utilized.
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Affiliation(s)
- Kosuke Toda
- Department of Surgery, Otsu City Hospital, 2-9-9 Motomiya, Otsu, Shiga, 520-0804, Japan.
| | - Taro Aoyama
- Department of Surgery, Otsu City Hospital, 2-9-9 Motomiya, Otsu, Shiga, 520-0804, Japan
| | - Kenjiro Hirai
- Department of Surgery, Otsu City Hospital, 2-9-9 Motomiya, Otsu, Shiga, 520-0804, Japan
| | - Taisuke Uemura
- Department of Surgery, Otsu City Hospital, 2-9-9 Motomiya, Otsu, Shiga, 520-0804, Japan
| | - Haruku Fujita
- Department of Surgery, Otsu City Hospital, 2-9-9 Motomiya, Otsu, Shiga, 520-0804, Japan
| | - Asami Okabe
- Department of Surgery, Otsu City Hospital, 2-9-9 Motomiya, Otsu, Shiga, 520-0804, Japan
| | - Hidenori Ohe
- Department of Surgery, Otsu City Hospital, 2-9-9 Motomiya, Otsu, Shiga, 520-0804, Japan
| | - Tsuyoshi Tachibana
- Department of Surgery, Otsu City Hospital, 2-9-9 Motomiya, Otsu, Shiga, 520-0804, Japan
| | - Akira Mitsuyoshi
- Department of Surgery, Otsu City Hospital, 2-9-9 Motomiya, Otsu, Shiga, 520-0804, Japan
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