Presentation Authors: Hanson Zhao, Carrie A. Stewart, Colby P. Souders*, Gabriela Gonzalez, Christopher Gonzales-Alabastro, A. Lenore Ackerman, Karyn Eilber, Jennifer T. Anger, Los Angeles, CA
Introduction: The association between pelvic organ prolapse and defecatory symptoms is neither well understood nor well described. The decision to perform a posterior repair during sacrocolpopexy is usually based on surgeon discretion. While sacrocolpopexy alone can improve posterior wall defects, it may also cause defecatory symptoms and posterior wall prolapse. We describe our experience with de novo defecatory symptoms and new onset symptomatic rectocele after sacrocolpopexy.
Methods: We performed a retrospective review of 172 consecutive patients who underwent open or robotic sacrocolpopexy by three FPMRS surgeons at a single institution. We identified patients who developed de novo defecatory symptoms (ie obstruction, soiling, splinting) and/or newly symptomatic rectocele post operatively. We analyzed their characteristics, history of prior prolapse surgeries, physical exam changes, history of prior prolapse surgeries, and need for re-operation.
Results: Average follow up was 13.7 months. A total of nineteen (12%) patients developed de novo defecatory symptoms after sacrocolpopexy, nine of whom did not have a documented rectocele after sacrocolpopexy. 12/19 patients had a documented rectocele on preoperative exam, but only two patients underwent a concurrent posterior repair at the same time of sacrocolpopexy. These two patients also developed a recurrent rectocele. Four of the twelve patients with pre-operative rectocele had a persistent rectocele after sacrocolpopexy. Four patients developed a de novo rectocele after isolated sacrocolpopexy.
Conclusions: Although there is literature supporting sacrocolpopexy as sufficient in addressing posterior defects, 12% of patients in our series developed new onset defecatory symptoms, and 5.2% (9) developed defecatory dysfunction without rectocele. Patients should be counseled regarding risk of developing de novo defecatory symptoms after sacrocolpopexy. This may be due to anatomic overcorrection of anterior vaginal support relative to posterior support, sigmoid manipulation, or distortion of vaginal anatomy due to suture placement at the promontory (which is arguably not anatomic). Further prospective studies should investigate the etiology of defecatory symptoms after sacrocolpopexy so that preventive techniques can be performed.