The following is the summary of “Does Concomitant Pelvic Organ Prolapse Repair at the Time of Rectopexy Impact Rectal Prolapse Recurrence Rates? A Retrospective Review of the Prospectively Collected Pelvic Floor Disorders Consortium Quality Improvement Database Pilot” published in December 2022 issue of Diseases of the Colon & Rectum by Bordeianou, et al.
About 30% of women who present with rectal prolapse also have prolapse of a pelvic organ. If you want to avoid having any more surgeries done on your pelvic floor, combined repair is an option worth considering. No research, however, has been conducted on the effects of sealing the pouch of Douglas in a rectal prolapse repair to provide a small amount of middle compartment suspension. The purpose of this research was to determine whether or not middle compartment suspension affected the long-term success of repairs for rectal prolapse. Researchers also wanted to see if reducing the incidence and severity of postoperative constipation and fecal incontinence could be accomplished by incorporating a pouch of Douglas closure into the middle compartment suspension technique.
The design of this investigation was a multicenter retrospective database. Information was gathered from the Quality Improvement in Rectal Prolapse Surgery database maintained by the Pelvic Floor Disorders Consortium. Patients’ demographics, prior repairs, symptoms of fecal incontinence and obstructed defecation, and operative details such as the addition of concomitant gynecologic repairs, the use of mesh, posterior or ventral dissection, and sigmoidectomy were reported anonymously by surgeons at more than 20 sites (75% academic, 81% high volume). Patients who had an abdominal repair for rectal prolapse were included. Interventions included a study contrasting abdominal rectopexy techniques that included and did not include suspension of the middle compartment.
Excision and closure of the pouch of Douglas with colpopexy or culdoplasty constituted middle compartment suspension. The primary outcome of prolapse recurrence and secondary outcomes of incontinence and constipation were computed using univariate and multivariate regression by comparing patients who had rectopexy with and without middle compartment suspension.
Of the 198 patients (59% robotic) who received abdominal repairs, 138 (70%) also underwent middle compartment suspension. There was a correlation between early rectal prolapse recurrences and middle-compartment suspension. Adding a pouch to a Douglas repair was related with a reduction in short-term recurrences on multivariable regression after controlling for age, prior repairs, and the use of mesh. their data should be used with caution due to some limitations. Additional research into this finding is urgently required, ideally in the form of future studies that use an a priori, prospective definition of middle compartment suspension, validated measurement of associated disease, and longer follow-up. Their findings imply that a partial suspension of the middle compartment at the time of rectal prolapse repair may increase the short-term durability of the repair.