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Is Postoperative Bowel Function Related to Posterior Compartment Prolapse Repair?

Edenfield, Autumn L. MD*; Levin, Pamela J. MD; Dieter, Alexis A. MD*; Wu, Jennifer M. MD, MPH; Siddiqui, Nazema Y. MD, MHSc*

Female Pelvic Medicine & Reconstructive Surgery: March/April 2014 - Volume 20 - Issue 2 - p 90–94
doi: 10.1097/SPV.0000000000000048
Original Articles
Journal Club
Journal Club Q and A

Objectives This study aimed to assess how posterior repair (PR) affects change in bowel function in women undergoing anterior/apical surgery for prolapse.

Methods We performed a retrospective cohort study of women undergoing prolapse surgery. Our 2 cohorts were women who underwent anterior/apical prolapse surgery either with or without a PR. All women completed the short form of the Colorectal-Anal Distress Inventory (CRADI-8) preoperatively and 6 weeks postoperatively. We compared change in CRADI-8 scores between those who received PR versus those who did not.

Results Among 238 women who underwent anterior/apical prolapse surgery, 61 (26%) underwent PR, whereas 177 (74%) did not undergo PR. There were no significant differences in mean CRADI-8 scores at baseline or postoperatively, and scores improved significantly in both groups [baseline scores 23.2 (20.2) for PR vs 18.2 (19.3) for no PR, P = 0.12; postoperative scores 5.0 (10.5) for PR vs 8.4 (15.4) for no PR, P = 0.08]. For our primary outcome, we identified a significantly larger margin of symptom improvement in those who underwent PR compared to those who did not [mean CRADI-8 change scores 18.2 (20.1) for PR vs 9.9 (18.6) for no PR, P < 0.01]. In a linear regression model assessing postoperative CRADI-8 scores, women who underwent PR scored 4.9 points lower on the postoperative CRADI-8, suggesting more improvement in bowel-related symptoms, compared to those who did not undergo PR (95% confidence interval, 1.0, 8.8, P = 0.02).

Conclusions Women undergoing surgery for anterior/apical prolapse demonstrated significant improvements in bowel symptoms after surgery. Those receiving concomitant PR had a significantly greater margin of improvement.

Women undergoing surgery for anterior/apical prolapse have significant improvements in bowel symptoms after surgery, and women with concomitant posterior repair have a significantly greater margin of improvement in bowel function.

From the *Department of Obstetrics and Gynecology, Duke University, Durham, NC; †Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA; and ‡Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC.

Reprints: Autumn L. Edenfield, MD, Duke University Medical Center, 5324 McFarland Ave, Suite 310, Durham, NC 27707. E-mail: autumn.edenfield@duke.edu.

Dr Wu is a consultant for Procter & Gamble, has developed CME programming for Perinatal Resources, and has received funding from the National Institutes of Health, American Geriatrics Society, all for work unrelated to this manuscript. Dr Siddiqui has pending institutional grant submissions with Medtronic, AUGS/Astellas Research Grant, and the NICHD Pelvic Floor Disorders Network, all of which are unrelated to this manuscript. The other authors have declared they have no conflicts of interest.

© 2014 by Lippincott Williams & Wilkins