Abstract

BACKGROUND: 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.OBJECTIVE: 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.STUDY DESIGN: 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.RESULTS: 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).CONCLUSION: 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.

View details for DOI 10.1016/j.ajog.2022.05.050

View details for PubMedID 35654113