The treatment of obstructed defecation syndrome (ODS) in association with POP is currently characterized by individual approaches and methods. Sufficient data on standardized treatment options to give evidence-based advice to the women suffering is still missing. Women are treated by individual departments in a variety of individual approaches and the cases are seldom discussed between disciplines.

In urogynecological surgery, biological meshes are currently not recommended for sacrocolpopexy. However, the evidence is sparse. Increasing evidence will form the basis for standardized care for the benefit of our patients at a time when the use of a synthetic meshes is being debated. 

In this study we initiated an interdisciplinary surgical approach and included a novel treatment option using a biological mesh material for our patients. The study investigates the feasibility of the laparoscopic resection rectopexy combined with mesh sacrocolpopexy of a biological/resorbable mesh as an alternative to a synthetic mesh.

Women who presented with an ODS combined with POP were operated in an interdisciplinary approach. All patients underwent laparoscopic resection rectopexy with mesh sacrocolpopexy using either synthetic or biologic mesh.
The primary endpoint is postoperative morbidity and mortality measured by the Clavien-Dindo-Classification (CDC) at 12 months after surgery. Further endpoints are the results of reconstruction 12 months with regard to pelvic floor stability and improvement of bowel evacuation based on scores (Altomare, modified Longo, rectal toxicity score; quality of life according to the SF 312 and PHQ 9 score), the control imaging with MRI defecography, and the costs of treatment between the two groups assessed by time-derived basic costs (TDBC).

So far, 26 patients have been operated so far. The table summarizes the results with a median follow-up of 10 months (3 – 15 months) (Table).

Based on these results to date, we advocate for the interdisciplinary approach. For the first time the medical condition of the patients involved is addressed with an interdisciplinary surgical approach offering a biological mesh as an alternative to the standardized synthetic mesh material. The use of a biological mesh in this setting is safe and feasible and offers an additional treatment option, especially for younger and fertile women.

In a further step, we plan a confirmatory multicenter trial to confirm that the biological mesh material offers comparable outcomes to synthetic mesh with. The increasing evidence will form the basis for standardized care for the benefit of our patients at a time when the use of a synthetic meshes is being debated.