Transvaginal sacrospinous ligament suture rectopexy for obstructed defecation symptoms: 1-year outcomes

Abstract

Introduction and hypothesis The current study was aimed at investigating the safety, efficiency, and durability of transvaginal sacrospinous ligament suture rectopexy in women with obstructed defecation symptoms (ODS) and significant rectal hypermobility/folding. Methods This was a prospective case series study performed during December 2018 to July 2020. Women presenting to our center with pelvic organ prolapse electing for surgical treatment were screened for ODS utilizing the PFDI-20 questionnaire. Patients were eligible for inclusion if they reported OD symptoms accompanying >50% of bowel movements (BMs), BM frequency ≥3 per week, stool type 3 or 4 based on the Bristol stool chart, absence of dyssynergic Valsalva, and dynamic ultrasound indicating a rectal compression ratio >25%. Patients underwent transvaginal sacrospinous ligament rectopexy and were followed up at 2 and 12 months postoperatively. Results A total of 20 patients underwent the procedure and completed the follow-up. Statistically significant improvements were observed in all OD symptoms and subjective improvement (94.7% ± 13.4 and 90.6% ± 18) at 2 and 12 months after the surgery respectively. Mean rectal compression ratio, detected via ultrasound, improved from 45.5% ± 18.4 preoperatively to 9.2% ± 13.7 at 2 months (p < 0.0001) and 19.6% ± 14.4 at 12 months (p < 0.0012). Surgical failure, defined as combined subjective (ODS >50% of bowel movements) and anatomical failure (rectal compression ratio >25%), occurred in 2 patients. Conclusion Transvaginal sacrospinous ligament suture rectopexy was safe, feasible, and effectively treated ODS within this cohort of women undergoing POP surgery with rectal hypermobility confirmed by dynamic ultrasound.

The Effect of Transvaginal Prolapse Surgery on Anorectal Function

“…24 Similarly, a prospective case series on twenty patients undergoing transvaginal SSF demonstrated statistically significant improvements in obstructed defecation symptoms using the Pelvic Floor Disability Index (PFDI-20) questionnaire. 25 Finally, other studies 26 have commented on improvements in general colonic symptomatology after SSF surgery, but have not distinguished between fecal incontinence or obstructed defecation syndrome symptoms. Our results augment these previous reports, showing with validated scores that transvaginal prolapse surgery positively influenced both obstructed defecation and fecal incontinence symptoms in our group.…”