Multidisciplinary Approach to the Treatment of Concomitant Rectal and Vaginal Prolapse

Abstract

Rectal prolapse and vaginal prolapse have traditionally been treated as separate entities despite sharing a common pathophysiology. This compartmentalized approach often leads to frustration and suboptimal outcomes. In recent years, there has been a shift to a more patient-centered, multidisciplinary approach. Procedures to repair pelvic organ prolapse are divided into three categories: abdominal, perineal, and a combination of both. Most commonly, a combined minimally invasive abdominal sacral colpopexy and ventral rectopexy is performed to treat concomitant rectal and vaginal prolapse. Combining the two procedures adds little operative time and offers complete pelvic floor repair. The choice of minimally invasive abdominal prolapse repair versus perineal repair depends on the patient's comorbidities, previous surgeries, preference to avoid mesh, and physician's expertise. Surgeons should at least be able to identify these patients and provide the appropriate treatment or refer them to specialized centers.

Keywords

sacral colpopexy - rectopexy - pelvic organ prolapse

• References

• 1 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 (9) 1412-1421
• 2 González-Argenté FX, Jain A, Nogueras JJ, Davila GW, Weiss EG, Wexner SD. Prevalence and severity of urinary incontinence and pelvic genital prolapse in females with anal incontinence or rectal prolapse. Dis Colon Rectum 2001; 44 (7) 920-926
• 3 Collopy BT, Barham KA. Abdominal colporectopexy with pelvic cul-de-sac closure. Dis Colon Rectum 2002; 45 (4) 522-526 , discussion 526–529
• 4 Baessler K, Schuessler B. Abdominal sacrocolpopexy and anatomy and function of the posterior compartment. Obstet Gynecol 2001; 97 (5, Pt 1) 678-684
• 5 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 (6) 688.e1-688.e5
• 6 Brown J. AAGL advancing minimally invasive gynecology worldwide: statement to the FDA on power morcellation. J Minim Invasive Gynecol 2014; 21 (6) 970-971
• 7 ACOG. ACOG practice bulletin no. 89. elective and risk-reducing salpingo-oophorectomy. Obstet Gynecol 2008; 111 (1) 231-241
• 8 Tekelioglu UY, Erdem A, Demirhan A , et al. The prolonged effect of pneumoperitoneum on cardiac autonomic functions during laparoscopic surgery; are we aware?. Eur Rev Med Pharmacol Sci 2013; 17 (7) 895-902
• 9 Danic MJ, Chow M, Alexander G, Bhandari A, Menon M, Brown M. Anesthesia considerations for robotic-assisted laparoscopic prostatectomy: a review of 1,500 cases. J Robot Surg 2007; 1 (2) 119-123
• 10 Gurland B. Ventral mesh rectopexy: is this the new standard for surgical treatment of pelvic organ prolapse?. Dis Colon Rectum 2014; 57 (12) 1446-1447
• 11 Watadani Y, Vogler SA, Warshaw JS , et al. Sacrocolpopexy with rectopexy for pelvic floor prolapse improves bowel function and quality of life. Dis Colon Rectum 2013; 56 (12) 1415-1422
• 12 Unger CA, Paraiso MF, Jelovsek JE, Barber MD, Ridgeway B. Perioperative adverse events after minimally invasive abdominal sacrocolpopexy. Am J Obstet Gynecol 2014; 211 (5) 547.e1-547.e8
• 13 VanderPas Lamb S, Massengill J, Sheridan MJ, Stern LE, von Pechmann W. Safety of combined abdominal sacral colpopexy and sigmoid resection with suture rectopexy: a retrospective cohort study. Female Pelvic Med Reconstr Surg 2015; 21 (1) 18-24
• 14 Walters MDKM. Urogynecology and Reconstructive Pelvic Surgery. 4th ed. Philadelphia, PA: Mosby, Inc; 2014
• 15 Siddiqui NY, Grimes CL, Casiano ER , et al; Society of Gynecologic Surgeons Systematic Review Group. Mesh sacrocolpopexy compared with native tissue vaginal repair: a systematic review and meta-analysis. Obstet Gynecol 2015; 125 (1) 44-55
• 16 Kapoor DS, Sultan AH, Thakar R, Abulafi MA, Swift RI, Ness W. Management of complex pelvic floor disorders in a multidisciplinary pelvic floor clinic. Colorectal Dis 2008; 10 (2) 118-123