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Al-Nejar A, Van den Broeck S, Smets Q, Plaeke P, Spinhoven M, Hubens G, Komen N. Ventral mesh rectopexy. Does a descending perineum impact functional results and quality of life? Langenbecks Arch Surg 2024; 409:44. [PMID: 38240901 DOI: 10.1007/s00423-024-03236-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 01/09/2024] [Indexed: 01/23/2024]
Abstract
PURPOSE The impact of perineal descent (PD) on functional outcome and quality of life after ventral mesh rectopexy (VMR) is unknown. The purpose of this study was to analyze the effect of PD on the functional outcome and quality of life (QOL) after VMR. METHODS A retrospective analysis was performed on fifty-five patients who underwent robotic VMR between 2018 and 2021. Pre and postoperative data along with radiological studies were gathered from a prospectively maintained database. The Cleveland Clinic Constipation score (CCCS), the Rome IV criteria and the 36-Item Short-Form Health Survey (SF-36), were used to measure functional results and QOL. RESULTS All 55 patients (mean age 57.8 years) were female. Most patients had radiological findings of severe PD (n = 31) as opposed to mild/moderate PD (n = 24). CCCS significantly improved at 3 months and 1 year post-VMR (mean difference = -4.4 and -5.4 respectively, p < 0.001) with no significant difference between the two groups. The percentage of functional constipation Rome IV criteria only showed an improved outcome at 3 months for severe PD and at 1 year for mild/moderate PD (difference = -58.1% and -54.2% respectively, p < 0.05). Only the SF-36 subscale bodily pain significantly improved in the mild/moderate PD group (mean difference = 16.7, p = 0.002) 3 months post-VMR which subsided after one year (mean difference = 5.5, p = 0.068). CONCLUSION Severe PD may impact the functional outcome of constipation without an evident effect on QOL after VMR. The results, however, remain inconclusive and further research is warranted.
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Affiliation(s)
- Ali Al-Nejar
- Department of Abdominal Surgery, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Belgium.
- Antwerp ReSURG, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Edegem, Belgium.
| | - Sylvie Van den Broeck
- Department of Abdominal Surgery, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Belgium
- Antwerp ReSURG, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Edegem, Belgium
| | - Quinten Smets
- Department of Abdominal Surgery, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Belgium
- Antwerp ReSURG, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Edegem, Belgium
| | - Philip Plaeke
- Department of Abdominal Surgery, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Belgium
- Antwerp ReSURG, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Edegem, Belgium
| | - Maarten Spinhoven
- Department of Radiology, Antwerp University Hospital, Edegem, Belgium
| | - Guy Hubens
- Department of Abdominal Surgery, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Belgium
- Antwerp ReSURG, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Edegem, Belgium
- Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Niels Komen
- Department of Abdominal Surgery, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Belgium
- Antwerp ReSURG, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Edegem, Belgium
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Van den Broeck S, Nullens S, Jacquemyn Y, De Schepper H, Vermandel A, Komen N. Posterior compartment prolapse and perineal descent: systematic review of available support devices. Int Urogynecol J 2023; 34:2629-2645. [PMID: 37074368 DOI: 10.1007/s00192-023-05508-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 03/01/2023] [Indexed: 04/20/2023]
Abstract
OBJECTIVE The aim of our study is to systematically review the literature about available devices facilitating perineal support during defecation in patients with obstructive defecation syndrome (ODS) and posterior pelvic organ prolapse (POP). METHODS We searched for the terms "defecat/ion or ODS" and" pessar/ies or device/aid/tool/perineal/perianal/prolapse and support" in MEDLINE, PubMed and Web of Science. Data abstraction was performed according to PRISMA (Preferred Reporting Items for Systematic reviews and Meta-analysis) guidelines. A two-stage inclusion was performed, selecting first on title and abstract and secondly the full text. For variables with sufficient data, a meta-analysis was performed using a random-effects model. Other variables were descriptively reported. RESULTS Ten studies out of 1332 were included for systematic review. The devices could be categorized into three groups: pessaries (n = 8), vaginal stent (n = 1) and external support device (n = 1). Methodology and data reporting is heterogeneous. Meta-analysis could be performed for the Colorectal-Anal Distress Inventory (CRADI-8) and Impact Questionnaire (CRAI-Q-7) in three pessary studies which showed a significant mean change. Significant improvement of stool evacuation was seen in two other pessary studies. The vaginal stent significantly decreases ODS. Subjective perception of constipation improved significantly using the posterior perineal support device. CONCLUSION All reviewed devices seem to improve ODS in patients with POP. There are no data on their efficacy with regard to perineal descent-associated ODS. There is a lack of comparative studies between devices. Studies are difficult to compare due to different inclusion criteria and evaluation tools.
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Affiliation(s)
- Sylvie Van den Broeck
- Department of Abdominal, Pediatric and Reconstructive Surgery, Antwerp University Hospital, 2650, Edegem, Belgium.
- Antwerp ReSURG, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, University of Antwerp, 2610, Antwerp, Belgium.
| | - Sara Nullens
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, 2650, Edegem, Belgium
| | - Yves Jacquemyn
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, 2610, Antwerp, Belgium
- Department of Obstetrics and Gynaecology, Antwerp University Hospital, 2650, Edegem, Belgium
- Global Health Institute (GHI), Faculty of Medicine and Health Sciences, University of Antwerp, 2610, Antwerp, Edegem, Belgium
| | - Heiko De Schepper
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, 2650, Edegem, Belgium
| | - Alexandra Vermandel
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, 2610, Antwerp, Belgium
| | - Niels Komen
- Department of Abdominal, Pediatric and Reconstructive Surgery, Antwerp University Hospital, 2650, Edegem, Belgium
- Antwerp ReSURG, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, University of Antwerp, 2610, Antwerp, Belgium
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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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