Original Article

Outlet Constipation 1 Year After Robotic Sacrocolpopexy With and Without Concomitant Posterior Repair

Authors: Andrea Kuntaraf Crane, MD, Elizabeth Joanne Geller, MD, Catherine Ann Matthews, MD

Abstract

Objectives: The aim of this study was to estimate the rate of outlet constipation at 1 year after robotic sacrocolpopexy (RSCP) with and without a concomitant distal posterior repair (PR). We sought, first, to determine the rate of persistent outlet constipation and second, to determine de novo outlet constipation.

Methods: This was a cohort study of women who underwent RSCP alone versus RSCP + PR, at each surgeon’s discretion, between November 2007 and February 2011 at an academic center. Specific questions in the Pelvic Floor Distress Inventory Short Form correlating to outlet constipation and its colorectal-anal subscale scores were compared between and within groups. Rates of posterior compartment reoperation were assessed.

Results: Of the 77 women who underwent RSCP, 21 (27%) had a concomitant distal PR. Overall, there was significant improvement in pelvic floor function and quality of life at 1 year after surgery (P = 0.01). Preoperatively, outlet constipation was present in 63.4% of those who underwent RSCP only and in 53.3% of those with concomitant PR. Postoperatively at 1 year, 56% of preoperative outlet constipation resolved and 44% persisted (P = 0.001), with no differences between groups (RSCP vs RSCP + PR). The rate of postoperative de novo outlet constipation was 13.6%. At 1 year after RSCP, 18.2% of patients had symptomatic posterior prolapse, with no difference between both groups (P = 0.746). Overall, 11.7% underwent a subsequent PR, none of whom underwent PR with the initial RSCP (P = 0.104).

Conclusions: At 1 year after RSCP, there was a high rate of persistent outlet constipation and a moderate rate of de novo outlet constipation. Concomitant PR did not significantly affect these bowel symptoms.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Spence-Jones C, Kamm MA, Henry MM, et al. Bowel dysfunction: a pathogenic factor in uterovaginal prolapse and urinary stress incontinence. Br J Obstet Gynaecol. 1994; 101: 147–152.
 
2. Weber AM, Walters MD, Ballard LA, et al. Posterior vaginal prolapse and bowel function. Am J Obstet Gynecol. 1998; 179: 1446–1449.
 
3. Baessler K, Schuessler B. Abdominal sacrocolpopexy and anatomy and function of the posterior compartment. Obstet Gynecol. 2001; 97: 678–684.
 
4. Jelovsek JE, Walters MD, Paraiso MF, et al. Functional bowel disorders and pelvic organ prolapse: a case-control study. Female Pelvic Med Reconstr Surg. 2010; 16: 209–214.
 
5. Ellerkmann RM, Cundiff GW, Melick CF, et al. Correlation of symptoms with location and severity of pelvic organ prolapse. Am J Obstet Gynecol. 2001; 185: 1332–1337.
 
6. Bradley CS, Brown MB, Cundiff GW, et al. Bowel symptoms in women planning surgery for pelvic organ prolapse. Am J Obstet Gynecol. 2006; 195: 1814–1819.
 
7. Cundiff GW, Fenner D. Evaluation and treatment of women with rectocele: focus on associated defecatory and sexual dysfunction. Obstet Gynecol. 2004; 104: 1403–1421.
 
8. Kahn MA, Breitkopf CR, Valley MT, et al. Pelvic Organ Support Study (POSST) and bowel symptoms: straining at stool is associated with perineal and anterior vaginal descent in a general gynecologic population. Am J Obstet Gynecol. 2005; 192: 1516–1522.
 
9. Mouritsen L, Larsen JP. Symptoms, bother and POPQ in women referred with pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct. 2003; 14: 122–127.
 
10. Gustilo-Ashby AM, Paraiso MF, Jelovsek JE, et al. Bowel symptoms 1 year after surgery for prolapse: further analysis of a randomized trial of rectocele repair. Am J Obstet Gynecol. 2007; 197: 76.e1–76.e5.
 
11. Puigdollers A, Fernandez-Fraga X, Azpiroz F. Persistent symptoms of functional outlet obstruction after rectocele repair. Colorectal Dis. 2007; 9: 262–265.
 
12. Bradley CS, Nygaard IE, Brown MB, et al. Bowel symptoms in women 1 year after sacrocolpopexy. Am J Obstet Gynecol. 2007; 197: 642.e1–642.e8.
 
13. Nygaard IE, McCreery R, Brubaker L, et al. Abdominal sacrocolpopexy: a comprehensive review. Obstet Gynecol. 2004; 104: 805–823.
 
14. Thornton MJ, Lam A, King DW. Bowel, bladder and sexual function in women undergoing laparoscopic posterior compartment repair in the presence of apical or anterior compartment dysfunction. Aust N Z J Obstet Gynaecol. 2005; 45: 195–200.
 
15. Xiromeritis P, Marotta ML, Royer N, et al. Outcome of laparoscopic sacrocolpopexy with anterior and posterior mesh. Hippokratia. 2009; 13: 101–105.
 
16. Geller EJ, Siddiqui NY, Wu JM, et al. Short term outcomes of robotic sacrocolpopexy compared with abdominal sacrocolpopexy. Obstet Gynecol. 2008; 112: 49–55.
 
17. Geller EJ, Parnell BA, Dunivan GC. Pelvic floor function before and after robotic sacrocolpopexy: one-year outcomes. J Minim Invasive Gynecol. 2011; 18: 322–327.
 
18. Salamon CG, Culligan PJ. Subjective and objective outcomes 1 year after robotic-assisted laparoscopic sacrocolpopexy. J Robot Surg. 2013; 7: 35–38.
 
19. Geller EJ, Barbee ER, Wu JM, et al. Validation of telephone administration of 2 condition- specific quality-of-life questionnaires. Am J Obstet Gynecol. 2007; 197: 632.e1–632.e4.
 
20. Barber MD, Walters MD, Bump RC. Short forms of two condition-specific quality-of-life questionnaires for women with pelvic floor disorders (PFDI-20 and PFIQ-7). Am J Obstet Gynecol. 2005; 193: 103–113.
 
21. Bump RC, Mattiasson A, Bo K, et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol. 1996; 175: 10–17.
 
22. Parnell BA, Matthews CA. Robot-assisted techniques and outcomes in the realm of pelvic reconstructive surgery. Clin Obstet Gynecol. 2011; 54: 412–419.
 
23. Ramanah R, Ballester M, Chereau E, et al. Anorectal symptoms before and after laparoscopic sacrocolpoperineopexy for pelvic organ prolapse. Int Urogynecol J. 2012; 23: 779–783.
 
24. Fox SD, Stanton SL. Vault prolapse and rectocele: assessment of repair using sacrocolpopexy with mesh interposition. BJOG. 2000; 107: 1371–1375.
 
25. Kaser DJ, Kinsler EL, Mackenzie TA, et al. Anatomic and functional outcomes of sacrocolpopexy with or without posterior colporraphy. Int Urogynecol J. 2012; 23: 1215–1220.
 
26. Shiozawa T, Huebner M, Hirt B, et al. Nerve-preserving sacrocolpopexy: anatomical study and surgical approach. Eur J Obstet Gynecol Reprod Biol. 2010; 152: 103–107.
 
27. Dallenbach P, Jungo Nancoz C, Eperon I, et al. Incidence and risk factors for reoperation of surgically treated pelvic organ prolapse. Int Urogynecol J. 2012; 23: 35–41.