Does concurrent posterior repair for an asymptomatic rectocele reduce the risk of surgical failure in patients undergoin
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ORIGINAL ARTICLE
Does concurrent posterior repair for an asymptomatic rectocele reduce the risk of surgical failure in patients undergoing sacrocolpopexy? Olivia H. Chang 1
&
Emily R. W. Davidson 1 & Tonya N. Thomas 1 & Marie Fidela R. Paraiso 1 & Cecile A. Ferrando 1
Received: 1 November 2019 / Accepted: 17 February 2020 # The International Urogynecological Association 2020
Abstract Purpose To determine if a concurrent posterior repair for an asymptomatic rectocele at the time of sacrocolpopexy reduces the incidence of surgical failure. Methods This is a retrospective chart review with a cross‐sectional follow-up survey of all patients who underwent sacrocolpopexy from 2004 to 2014. Demographic and operative data were collected from the medical record. For the crosssectional portion, patients were contacted to obtain information on symptoms and retreatment after surgery. In this study, we included patients with an asymptomatic rectocele on examination, defined as Ap or Bp ≥ −1 on POP-Q without defecatory dysfunction, which was defined as constipation based on the Rome III criteria, dyschezia, excessive straining and/or splinting to have a bowel movement. The primary outcome was a composite score of subjective bulge symptoms or retreatment for prolapse. Results Three hundred forty-four patients met the inclusion criteria: 185 (53.8%) had a sacrocolpopexy only (SCP) and 159 (46.2%) had a concurrent posterior repair (SCP + PR). The composite failure rate was 10.2% (95% CI = 7.4–13.8%), with a 13.5% (25) failure rate in the SCP group compared with 6.3% (10) in the SCP + PR group (p = 0.03). On multivariable logistic regression, the adjusted odds of failure was 2.79 in the SCP compared with the SCP + PR group (CI 1.25-6.23; P = 0.01). The rates of de novo defecatory dysfunction following surgery were low (SCP = 5.6% vs. SCP + PR = 7.5%, p = 0.55). Conclusions For patients with asymptomatic rectoceles, a concurrent posterior repair at the time of sacrocolpopexy reduces the odds of composite patient-centered failure without an increased rate of dyspareunia or de novo defecatory dysfunction. Keywords Sacrocolpopexy . Prolapse recurrence . Posterior colporrhaphy . Rectocele . Defecatory dysfunction . Pelvic organ prolapse
Introduction Sacrocolpopexy is a durable treatment option for women with symptomatic pelvic organ prolapse. The success rates associated with sacrocolpopexy range from 74% to 94% depending on the definition of treatment success [1–3]. In a recent Cochrane review, when compared with vaginal procedures
This manuscript was presented as a poster at the joint AUGS/IUGA scientific meeting in 2019 in Nashville, TN. * Olivia H. Chang [email protected] 1
Center for Urogynecology and Pelvic Reconstructive Surgery, Cleveland Clinic, 9500 Euclid Ave, Desk A81, Cleveland, OH 44195, USA
for apical suspension, patients who underwent sacrocolpopexy were less likely to be aware of their prolapse, have anatomic recurrent prolapse or need repeat surgery at 2 years [4]. Some surgeons advocate for a posterior repair and
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