Obstructive defecation syndrome (ODS) is a disturbed defecation process due to a protrusion of the lower rectum or intussusception and frequently associated with chronic obstipation and pelvic organ prolapse (POP) in women. The quality of life of affected patients is substantially compromised, especially among younger patients. Conservative treatment options are often limited to slightly improvement of patients´ symptoms, and do not achieve cure. Surgical interventions aim to the anatomical reconstruction of the bowel and pelvic holding apparatus. So far, these surgical interventions are characterized by individual approaches and methods of each individual department and sufficient data on standardized interdisciplinary treatment options are missing.

The study investigates the feasibility of a standardized laparoscopic resection rectopexy combined with mesh sacrocolpopexy (either biological/resorbable mesh or synthetic mesh) in an interdisciplinary setting. So far, there is no interdisciplinary approach for ODS in women and the use of a biological/resorbable mesh in combination with a resection rectopexy. For the first time, this is a promising novel treatment alternative, in an interdisciplinary setting especially in premenopausal women.

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. Primary endpoint is postoperative morbidity and mortality measured by the Clavien-Dindo-Classification (CDC) at 12 months after surgery. Further endpoints are relapse of prolapse 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).

Between 2020 and 2021, 26 patients were operated on this interdisciplinary approach with a median follow-up of 14 months (7 – 19 months). In five cases a biological mesh was used (3 due to patients’ preference and 2 due to planned pregnancy). Grades of complications according to CDC and frequency of postoperative complications were low. Anatomical outcomes were excellent.

The combined approach is safe, feasible, and effective to treat the medical condition.

For the first time, the medical condition of the patients involved is addressed with an interdisciplinary surgical approach instead of a variety of individual treatment approaches which are seldom discussed and addressed between disciplines. Additionally, a biological mesh as an alternative to the standardized synthetic mesh is offered for sacrocolpopexy. The use of a biological mesh in combination with a resection rectopexy is safe and feasible and offers an additional treatment option, especially for younger and fertile women.