Faisabilité du traitement concomitant du prolapsus rectal et génital par prothèse par voie vaginale avec rectopexie

Abstract

IntroductionRectal prolapse commonly affects older women, coexists with other pelvic organ prolapses, and is responsible for the disabling digestive symptoms. One of its treatments is rectopexy. The vaginal approach, less invasive compared to surgery, seems to be preferable for fragile patients.ObjectiveFeasibility of a surgical concomitant treatment of a rectal and pelvic prolapse with a mesh sutured to the rectum during a vaginal approach.Material and methodProspective observational study in 2009 included patients with a pelvic organ and a rectal prolapse, requiring a surgical treatment, with contraindication to laparoscopy. Prolapse repair was performed using Prolift® (posterior mesh sutured to anterior and lateral rectal sides). Anatomic and functional assessment before and after surgery was conducted through: validated questionnaire, clinical examination, pelvic MRI, defecography, satisfaction assessment.ResultsSeven patients were included (mean age = 68 ± 6 years old [57–75]). Two months after surgery: any clinical pelvic organ prolapse (P < 0.05), one rectal prolapse was observed on MRI and defecography (patient without symptoms). Six months after surgery: mean Gastrointestinal Quality of Life Index decreased (P < 0.05). The mean Miller and Kess score decreased too but not significantly. Four patients (57%) were very satisfied with the result, would undergo operation again, and recommend it. Five (71%) were very satisfied with the time they went back to usual activity. Any complication during or after surgery was observed.ConclusionOur study shows the feasibility of a concomitant vaginal treatment of rectal and pelvic prolapse, using Prolift® mesh, with a low short-term morbidity. The longterm benefit must be studied on a larger population.