There is a growing interest in combined pelvic organ prolapse (POP) and rectal prolapse (RP) surgery for concomitant pelvic floor prolapse despite a paucity of data regarding complications and clinical outcomes of combined repair.
The primary objective of this study was to compare the <30-day postoperative complication rate in women undergoing combined POP+RP surgery to those undergoing POP-only surgery. The secondary objectives were to describe the <30-day postoperative complications, to compare POP recurrence between the two groups and to determine preoperative predictors of <30-day postoperative complications and predictors of POP recurrence.
This was a multicenter, retrospective cohort study at five academic hospitals. Patients undergoing combined POP+RP surgery were matched by age, POP stage by leading compartment and POP procedure to those undergoing POP-only surgery from March 2003 to March 2020. The primary outcome measure was <30-day complications separated into Clavien-Dindo (CD) classes. Secondary outcome measures were 1) subsequent POP surgeries and 2) POP recurrence, defined as patients who complained of vaginal bulge symptoms postoperatively.
Two hundred and four women underwent combined surgery for POP+RP and 204 women underwent surgery for POP-only. Average age (59.3+1.0 vs 59.0+1.0) and mean parity (2.3+1.5 vs 2.6+1.8) was similar in each group. One hundred and nine patients (26.7%) had at least one <30-day postoperative complication. The proportion of patients who had a complication in the combined group and POP-only group was similar (27.5% vs 26.0%, p=0.82). CD scores were similar between the groups (10.3% vs 9.3% Grade 1, 11.8% vs 12.3% Grade 2, 3.9% vs 4.4% Grade 3, 1.0% vs 0% Grade 4, 0.5% vs 0% Grade 5). Combined patients were less likely than POP-only patients to develop postoperative UTIs and urinary retention but were more likely to be treated for wound infections and pelvic abscesses. After adjusting for combined vs POP-only surgery and parity, patients who had anti-incontinence procedures (aOR=1.85, 95% CI 1.16, 2.94, p=0.02) and perineorrhaphies (aOR=1.68, 95% CI 1.05, 2.70, p=0.02) were more likely to have <30-day postoperative complications. Twelve patients in the combined group and 15 patients in the POP-only group (5.9% vs 7.4%, p=0.26) had subsequent POP repairs. In the combined group, 10 patients (4.9%) underwent one repair and 2 patients (1.0%) underwent two repairs. All patients who had recurrent POP surgery in the POP-only group had one subsequent POP repair. Twenty-one patients in the combined surgery group and 28 patients in the POP-only group (10.3% vs 13.7%, p=0.26) reported recurrent POP. On multivariable analysis adjusted for number of prior POP repairs, combined vs POP-only group and perineorrhaphy at the time of surgery, patients were more likely to have a subsequent POP surgery if they had had 2 or more prior POP repairs (aOR=6.06, 95% CI 2.10, 17.5, p=0.01). Average follow-up time was 307.2+31.5 days for the combined cohort and 487.7+49.9 days for the POP-only cohort. Survival curves indicated that the median time-to-recurrence was not statistically significant (log rank, p=0.265) between the combined group (4.2+0.4 years) and POP-only group (5.6+0.4 years).
In this retrospective cohort study, patients undergoing combined POP+RP surgery had a similar risk of <30-day postoperative complications compared to patients undergoing POP-only surgery. Combined patients also had a similar risk of recurrent POP and subsequent POP surgery compared to patients undergoing POP-only surgery.
American journal of obstetrics and gynecology. 2022 May 30 [Epub ahead of print]
Shannon L Wallace, Youngwu Kim, Erica Lai, Shailja Mehta, Bertille Gaigbe-Togbe, Chiyuan Amy Zhang, Emily C Von Bargen, Eric R Sokol
Women's Health Institute, Division of Urogynecology and Pelvic Floor Disorders, Cleveland Clinic Foundation, Cleveland, OH, United States. Electronic address: ., Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, United States., Department of Obstetrics and Gynecology, Northwell Health, Great Neck, NY, United States., Department of Obstetrics and Gynecology, Yale University, New Haven, CT, United States., Department of Obstetrics and Gynecology, Mount Sinai Hospital, New York City, NY, United States., Department of Urology, Stanford University Hospital, Stanford, CA, United States., Department of Obstetrics and Gynecology, Division of Urogynecology and Pelvic Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, United States.