E-Posters-Trends in the Surgical Management of Combined Vaginal and Rectal Prolapse following the Initiation of a Multi-Disciplinary Pelvic Floor Center

Trends in the Surgical Management of Combined Vaginal and Rectal Prolapse following the Initiation of a Multi-Disciplinary Pelvic Floor Center - Shannon L. Wallace, MD

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A retrospective review was conducted to characterize changes in the surgical management of combined vaginal prolapse (POP) and rectal prolapse (RP) following the initiation of a multi-disciplinary pelvic floor center. The study collected data on patient demographics, surgical approach, and outcomes for female patients who received combined RP and POP surgery at a single tertiary care center from 2008-2019.<br /><br />The results showed a significant increase in the number of combined surgeries after the initiation of the multi-disciplinary center. The use of laparoscopic/robotic abdominal approach for RP repair increased, as did the use of mesh-based repair for both RP and POP. Before the center was established, open abdominal and transperineal repairs were more common for RP, and suture-based suspensions were more common for POP.<br /><br />Patient characteristics, such as age, race/ethnicity, BMI, and comorbidities, were similar before and after the center was established. However, patients treated after the center's initiation were less likely to be former or current smokers.<br /><br />The study concludes that a dedicated multi-disciplinary pelvic floor center can significantly increase the opportunity for combined surgeries for the treatment of vaginal and rectal prolapse. The increasing utilization of minimally-invasive approaches for RP and mesh-based repairs for POP highlights the importance of continued training in these procedures, despite the controversy surrounding mesh use in pelvic reconstruction.<br /><br />Overall, the findings suggest that combined surgical repair for vaginal and rectal prolapse via suture or mesh fixation to the sacral promontory is safe and has good outcomes. The establishment of a multi-disciplinary center with a dedicated pelvic floor colorectal surgeon can improve access to combined surgeries and optimize the treatment of patients with combined prolapse.

Keywords

retrospective review

surgical management

combined prolapse

multi-disciplinary center

laparoscopic/robotic approach

mesh-based repair

suture-based suspensions

patient demographics

treatment outcomes

pelvic floor colorectal surgeon