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INTRODUCTION: Rectocele vaginal repair (RVR) and the timing of this surgery in symptomatic women undergoing robotic assisted laparoscopic sacrocolpopexy (RS) for concomitant symptomatic apical pelvic organ prolapse (POP) are controversial. The aim of our study was to review our data in order to look for predictors that can help the algorithm for both treatment and timing of RVR in women with symptomatic apical prolapse undergoing RS.
METHODS: IRB approved single site retrospective cohort of women who had RS with concomitant mid-urethral sling, with/without hysterectomy and rectocele repair from April 2010 to February 2013 (prospectively maintained). Women with complete data and at least 12 months follow up were included in our review. Failure was determined by symptomatic patients who underwent repeat surgery or those considering repeat reconstructive surgery. Objective data was based on Baden-Walker grading system. We used PFDI-20 and PFIQ-7. Pearson’s Chi-square and Wilcoxon two sample test were used for categorical variables.
RESULTS: Complete follow up data was available for 137 of 150 women who underwent RS; 34 (25%) had concomitant RVR. There were 94 women with difficulty emptying their bowels or constipation (symptomatic) and 53 performed vaginal splint according to PFDI-20. All women who underwent RVR were symptomatic (34/94) and almost half of these were splinting (16/53). There were 13 (9%) women who had posterior POP failure at last follow up (mean 16 months) and three of these underwent previous rectocele repair (3/34). Sixty women did not have concomitant RVR and ten of these had posterior POP failure. When analyzing symptoms, preoperative splinting was significantly associated with failure in those patients who underwent concomitant repair (3/16 vs. 0/18, p=0.054). Furthermore, splinting was also associated with the need for rectocele repair in those who did not undergo concomitant RVR (9/37 vs. 1/23 p=0.044). Pelvic organ prolapse grading was not a significant predictor. All women who underwent simultaneous RVR had rectocele grade 2 or worse and this was not statistically associated with splinting (p=0.846). There was only one patient (0.007%) with failure at both anterior and apical compartments who underwent repeat surgery, but did not undergo RVR and did not develop bowel symptoms afterwards.
CONCLUSION: Our data suggests that symptomatic women who require to splint will benefit from concomitant RVR at the time of RS; nonetheless women undergoing concomitant RVR have a small risk of failure at the posterior compartment.