Full-thickness rectal prolapse frequently co-exists with pelvic organ prolapse in elderly women.  These patients are mostly qualified for two separate procedures: a perineal defect repair performed by gynecologists and then a rectal prolapse surgery carried out by surgeons. An alternative is a one-stage repair of both abnormalities.
The aim of the study was to compare the outcomes of one-stage rectal and pelvic organ prolapse surgery (Group A) with a two-stage procedure (Group B). The video shows the one stage operation technique.

23 female patients qualified for rectal prolapse treatment using the perineal approach were the subjects of the analysis over the period from 2012 to 2020. They also experienced pelvic organ prolapse and had been operated on previously or at the time of the rectal prolapse surgery. The patients were classified into two groups:
Group A – patients who underwent one-stage surgery for full-thickness rectal and pelvic organ surgery (RP+POP).
Group B – patients who underwent full-thickness rectal prolapse surgery and presented a history of pelvic organ prolapse repair (RP-POP).
The treatment outcomes were assessed based on the number of recurrent rectal and/or pelvic organ prolapse cases, complications and the patients’ quality of life before and after the procedure. Standard quality of life assessment scales (EQ5D and QoL) and the Wexner Score (for the assessment of gas and fecal incontinence) were applied. Concurrent constipation and urinary incontinence were assessed during the physical exam. In addition, an obstetric history was collected. Both groups were evaluated before the surgery and at 6 months (half a year) after the procedure. The follow-up period was 6 months to 62 months (mean value: 36 months). Both groups were comparable in terms of the age, gender and significance of the obstetric history. In the statistical analysis, the Wilcoxon test and descriptive statistics for the parameters with insufficient values were used.

The numbers of recurrence cases were 1 (A - 11%) and 2 (B - 14%), respectively. No complications were observed in either of the groups. The mean surgery time was longer in the one-stage surgery group (A - 124 min / B - 110 min). Improved quality of life (A - EQ5D - 15%, QoL - 13%; B - EQ5D - 22%, QoL - 23%) and functional parameters (decreased rates of constipation and incontinence: A - 63%, 51%; B - 46%, 40%) were observed in both groups following the surgeries. Too small group sizes do not allow for confirmation of the statistical significance of this difference.

1.	The treatment outcomes of one-stage pelvic organ and rectal prolapse surgery are comparable to those achieved by means of a two-stage procedure. The one-stage approach allows for a significant reduction of costs and risks related to double hospitalization, anesthesia and surgery.
2.	The small number of patients limits the potential for a comprehensive assessment of the statistical significance of differences at this stage of the research.

Continence 2S2 (2022) 100311
DOI: 10.1016/j.cont.2022.100311