Approaching Combined Rectal and Vaginal Prolapse

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.

Keywords

robotic rectopexy and sacrocolpopexy - rectal prolapsed - pelvic organ prolapsed - ventral rectopexy - sacrocolpopexy - multidisciplinary pelvic floor approach

Publication History

Article published online:
17 January 2022

• References

• 1 Altman D, Zetterstrom J, Schultz I. et al. Pelvic organ prolapse and urinary incontinence in women with surgically managed rectal prolapse: a population-based case-control study. Dis Colon Rectum 2006; 49 (01) 28-35
• 2 Nygaard I, Barber MD, Burgio KL. et al; Pelvic Floor Disorders Network. Prevalence of symptomatic pelvic floor disorders in US women. JAMA 2008; 300 (11) 1311-1316
• 3 Naldini G, Fabiani B, Sturiale A, Simoncini T. Complex pelvic organ prolapse: decision-making algorithm. Int J Colorectal Dis 2019; 34 (01) 189-192
• 4 Lim M, Sagar PM, Gonsalves S, Thekkinkattil D, Landon C. Surgical management of pelvic organ prolapse in females: functional outcome of mesh sacrocolpopexy and rectopexy as a combined procedure. Dis Colon Rectum 2007; 50 (09) 1412-1421
• 5 van Zanten F, van der Schans EM, Consten ECJ. et al. Long-term anatomical and functional results of robot-assisted pelvic floor surgery for the management of multicompartment prolapse: a prospective study. Dis Colon Rectum 2020; 63 (09) 1293-1301
• 6 Lee A, Kin C, Syan R, Morris A, Gurland B. Surgical decision-making for rectal prolapse: one size does not fit all. Postgrad Med 2019; 132 (03) 256-262
• 7 Daniel VT, Davids JS, Sturrock PR, Maykel JA, Phatak UR, Alavi K. Getting to the bottom of treatment of rectal prolapse in the elderly: analysis of the National Surgical Quality Improvement Program (NSQIP). Am J Surg 2019; 218 (02) 288-292
• 8 Suskind AM, Jin C, Walter LC, Finlayson E. Frailty and the role of obliterative versus reconstructive surgery for pelvic organ prolapse: a national study. J Urol 2017; 197 (06) 1502-1506
• 9 Jallad K, Gurland B. Multidisciplinary approach to the treatment of concomitant rectal and vaginal prolapse. Clin Colon Rectal Surg 2016; 29 (02) 101-105
• 10 Sajid MS, Siddiqui MR, Baig MK. Open vs laparoscopic repair of full-thickness rectal prolapse: a re-meta-analysis. Colorectal Dis 2010; 12 (06) 515-525
• 11 Tou S, Brown SR, Nelson RL. Surgery for complete (full-thickness) rectal prolapse in adults. Cochrane Database Syst Rev 2015; (11) CD001758
• 12 Mackenzie H, Dixon AR. Proficiency gain curve and predictors of outcome for laparoscopic ventral mesh rectopexy. Surgery 2014; 156 (01) 158-167
• 13 Barber MD, Walters MD, Bump RC. Short forms of two condition-specific quality-of-life questionnaires for women with pelvic floor disorders (PFDI-20 and PFIQ-7). Am J Obstet Gynecol 2005; 193 (01) 103-113
• 14 Swift S, Morris S, McKinnie V. et al. Validation of a simplified technique for using the POPQ pelvic organ prolapse classification system. Int Urogynecol J Pelvic Floor Dysfunct 2006; 17 (06) 615-620
• 15 Lawrence JM, Lukacz ES, Nager CW, Hsu JW, Luber KM. Prevalence and co-occurrence of pelvic floor disorders in community-dwelling women. Obstet Gynecol 2008; 111 (03) 678-685
• 16 Brubaker L, Cundiff GW, Fine P. et al; Pelvic Floor Disorders Network. Abdominal sacrocolpopexy with Burch colposuspension to reduce urinary stress incontinence. N Engl J Med 2006; 354 (15) 1557-1566
• 17 Cundiff GW, Varner E, Visco AG. et al; Pelvic Floor Disorders Network. Risk factors for mesh/suture erosion following sacral colpopexy. Am J Obstet Gynecol 2008; 199 (06) 688.e1-688.e5
• 18 Speed JM, Zhang CA, Gurland B, Enemchukwu E. Trends in the diagnosis and management of combined rectal and vaginal pelvic organ prolapse. Urology 2020; (e-pub ahead of print)
• 19 Geltzeiler CB, Birnbaum EH, Silviera ML. et al. Combined rectopexy and sacrocolpopexy is safe for correction of pelvic organ prolapse. Int J Colorectal Dis 2018; 33 (10) 1453-1459
• 20 Weinberg D, Qeadan F, McKee R, Rogers RG, Komesu YM. Safety of laparoscopic sacrocolpopexy with concurrent rectopexy: peri-operative morbidity in a nationwide cohort. Int Urogynecol J Pelvic Floor Dysfunct 2018
• 21 Reddy J, Ridgeway B, Gurland B, Paraiso MF. Robotic sacrocolpoperineopexy with ventral rectopexy for the combined treatment of rectal and pelvic organ prolapse: initial report and technique. J Robot Surg 2011; 5 (03) 167-173
• 22 van Iersel JJ, de Witte CJ, Verheijen PM. et al. Robot-assisted sacrocolporectopexy for multicompartment prolapse of the pelvic floor: a prospective cohort study evaluating functional and sexual outcome. Dis Colon Rectum 2016; 59 (10) 968-974
• 23 Unger CA, Paraiso MF, Jelovsek JE, Barber MD, Ridgeway B. Perioperative adverse events after minimally invasive abdominal sacrocolpopexy. Am J Obstet Gynecol 2014; 211 (05) 547.e1-547.e8
• 24 Campagna G, Panico G, Caramazza D. et al. Laparoscopic sacrocolpopexy plus ventral rectopexy as combined treatment for multicompartment pelvic organ prolapse. Tech Coloproctol 2020; 24 (06) 573-584
• 25 Culligan PJ, Murphy M, Blackwell L, Hammons G, Graham C, Heit MH. Long-term success of abdominal sacral colpopexy using synthetic mesh. Am J Obstet Gynecol 2002; 187 (06) 1473-1480 , discussion 1481–1482
• 26 Gregory WT, Otto LN, Bergstrom JO, Clark AL. Surgical outcome of abdominal sacrocolpopexy with synthetic mesh versus abdominal sacrocolpopexy with cadaveric fascia lata. Int Urogynecol J Pelvic Floor Dysfunct 2005; 16 (05) 369-374
• 27 Altman D, Anzen B, Brismar S, Lopez A, Zetterström J. Long-term outcome of abdominal sacrocolpopexy using xenograft compared with synthetic mesh. Urology 2006; 67 (04) 719-724
• 28 Balla A, Quaresima S, Smolarek S, Shalaby M, Missori G, Sileri P. Synthetic versus biological mesh-related erosion after laparoscopic ventral mesh rectopexy: a systematic review. Ann Coloproctol 2017; 33 (02) 46-51