Transvaginal Sacrospinous Rectopexy for Obstructed Defecation Syndrome

Leffelman A1, Chill H1, Goldberg R1, Rostami Nia G1

Research Type

Clinical

Abstract Category

Anorectal / Bowel Dysfunction

Abstract 180
Bowel Dysfunction
Scientific Podium Short Oral Session 23
Thursday 28th September 2023
16:22 - 16:30
Room 104CD
Surgery Bowel Evacuation Dysfunction Constipation
1. Female Pelvic Medicine and Reconstructive Surgery (FPMRS), Division of Urogynecology, University of Chicago, Northshore University HealthSystem, Skokie, IL, USA
Presenter
Links

Abstract

Introduction
Obstructed defecation syndrome (ODS) accounts for constipation in approximately 7% of adult females and frequently coexists with pelvic floor disorders such as pelvic organ prolapse, fecal incontinence, and urinary incontinence [1, 2]. Studies have demonstrated that among women presenting for urogynecologic care, 83% had at least one bowel symptom with incomplete evacuation and straining becoming most prevalent [1,3]. Most often, obstructive defecation results from anatomic defects in rectal structure and support [1,2]. Different surgical approaches have been described to correct rectal support defects that can be diagnosed as rectal prolapse, intussusception, enterocele or rectocele [3]. Transvaginal sacrospinous rectopexy has previously been published as a minimally invasive option in the treatment for rectal partial prolapse detected by dynamic rectal imaging [2]. In this video, we will review prior studies on ODS diagnosis and suture-based transvaginal sacrospinous rectopexy, present a case report presenting to our clinic for evaluation, and demonstrate the surgical steps and technique of this novel approach.
Design
In this video, we present a case report utilizing a transvaginal approach to sacrospinous rectopexy with a suture-based repair utilizing the sacrospinous ligaments for ODS in a 69-year-old female. A novel surgical technique was designed based on the anatomical location of rectum relative to sacrospinous ligament which is used for sacrospinous suspension. For this surgical technique, dissection is performed and carried down to the sacrospinous ligament and sutures are placed using a suture capturing device into each ligament approximately 2-2.5cm medial to the ipsilateral ischial spine. With one finger inside the rectum, the 0-PDS suture was passed through the lateral rectal ligament and rectal muscular layer as a two bite- running suture at a point 7-8cm cephalad to the anal verge. This suture is tied down and the procedure is repeated on the contralateral side.
Results
In our prior study evaluating the safety, efficacy and durability of the transvaginal sacrospinous rectopexy for obstructed defecation syndrome, greater than 90% of patients described improvement in all obstructed defecation symptoms and subjective improvement overall at 2 and 12 months after the surgery and improved rectal support detected via dynamic ultrasound [2].
Conclusion
Application of dynamic pelvic floor ultrasound enhanced our understanding of underlying anatomical defects for obstructed defecation symptoms and opened the opportunity to create a novel minimally-invasive, mesh-free solution for this prevalent problem in the urogynecologic patient population. The overall safety and efficacy profile of this novel approach is highly promising based on our experience thus far and will be further defined by long term studies currently in progress.
References
  1. Pratt, Toya, and Kavita Mishra. “Evaluation and Management of Defecatory Dysfunction in Women.” Current Opinion in Obstetrics & Gynecology, vol. 30, no. 6, Dec. 2018, pp. 451–57. DOI.org (Crossref), https://doi.org/10.1097/GCO.0000000000000495.
  2. Rostaminia, Ghazaleh, et al. “Transvaginal Sacrospinous Ligament Suture Rectopexy for Obstructed Defecation Symptoms: 1-Year Outcomes.” International Urogynecology Journal, vol. 32, no. 11, Nov. 2021, pp. 3045–52. Springer Link, https://doi.org/10.1007/s00192-020-04611-y.
  3. Riss, Stefan, and Anton Stift. “Surgery for Obstructed Defecation Syndrome - Is There an Ideal Technique.” World Journal of Gastroenterology, vol. 21, no. 1, Jan. 2015, pp. 1–5. PubMed, https://doi.org/10.3748/wjg.v21.i1.1.
Disclosures
Funding NONE Clinical Trial No Subjects Human Ethics Committee NorthShore Institutional Review Board Helsinki Yes Informed Consent Yes
Citation

Continence 7S1 (2023) 100898
DOI: 10.1016/j.cont.2023.100898

13/11/2024 19:26:38