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Rajasingh CM, Gurland BH. Management of Full Thickness Rectal Prolapse. SEMINARS IN COLON AND RECTAL SURGERY 2022. [DOI: 10.1016/j.scrs.2022.100938] [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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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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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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Ali HTO, Alqahtani SAS, Alqahtani MSS, Alasiri SA, Mgbel AS. Urinary Complications among Women with Cystoceles: A Systematic Review. INTERNATIONAL JOURNAL OF PHARMACEUTICAL RESEARCH AND ALLIED SCIENCES 2022. [DOI: 10.51847/yjik2qz5wi] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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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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Tamosiunas A, Klimsauskiene V, Dailidenas S, Eismontas V, Janušonis T, Samalavicius NE, Dulskas A. Laparoscopic posterior sutured rectopexy for full-thickness rectal prolapse in a male patient - a video vignette. Colorectal Dis 2021; 23:2206-2207. [PMID: 33993610 DOI: 10.1111/codi.15734] [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: 02/24/2021] [Revised: 03/28/2021] [Accepted: 04/05/2021] [Indexed: 02/08/2023]
Affiliation(s)
- Albinas Tamosiunas
- Department of Surgery, Klaipeda University Hospital, Klaipeda, Lithuania
| | | | - Sarunas Dailidenas
- Department of Surgery, Klaipeda University Hospital, Klaipeda, Lithuania
| | | | - Tomas Janušonis
- Department of Anaesthesiology and Intensive Care, Klaipeda University Hospital, Klaipeda, Lithuania.,Department of Pathology, Forensic Medicine and Pharmacology, Faculty of Medicine, Vilnius, Lithuania
| | - Narimantas E Samalavicius
- Department of Surgery, Klaipeda University Hospital, Klaipeda, Lithuania.,Institute of Clinical Medicine Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Health Research and Innovation Science Centre, Faculty of Health Sciences, Klaipeda University, Klaipeda, Lithuania
| | - Audrius Dulskas
- Institute of Clinical Medicine Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Department of General and Abdominal Surgery and Oncology, National Cancer Institute, Vilnius, Lithuania
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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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Samalavicius NE, Klimasauskiene V, Simcikas D, Stravinskas M, Eismontas V, Dulskas A. The Delorme procedure for full-thickness rectal prolapse - a video vignette. Colorectal Dis 2021; 23:762-763. [PMID: 33314539 DOI: 10.1111/codi.15484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/06/2020] [Accepted: 12/07/2020] [Indexed: 02/08/2023]
Affiliation(s)
- Narimantas E Samalavicius
- Department of Surgery, Klaipeda University Hospital, Klaipeda, Lithuania.,Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Health Research and Innovation Science Centre Faculty of Health Sciences, Klaipeda University, Klaipeda, Lithuania
| | | | - Dainius Simcikas
- Department of Surgery, Klaipeda University Hospital, Klaipeda, Lithuania.,Department of Nursing, Klaipeda University, Klaipeda, Lithuania
| | | | | | - Audrius Dulskas
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Departament of General and Abdominal Surgery and Oncology, National Cancer Institute, Vilnius, Lithuania
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