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Recurrence of Rectal Prolapse After Surgical Repair in Women With Pelvic Organ Prolapse

Catanzarite, Tatiana, M.D.1,2; Klaristenfeld, Daniel D., M.D.3; Tomassi, Marco J., M.D.3; Zazueta-Damian, Gisselle, S.R.A.2; Alperin, Marianna, M.D., M.S.1

Diseases of the Colon & Rectum: July 2018 - Volume 61 - Issue 7 - p 861–867
doi: 10.1097/DCR.0000000000001023
Original Contributions: Pelvic Floor
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BACKGROUND: Pelvic organ prolapse is prevalent among women with rectal prolapse.

OBJECTIVE: This study aimed to determine whether clinically significant pelvic organ prolapse impacts rectal prolapse recurrence after surgical repair.

DESIGN: A retrospective cohort.

SETTING: This study was performed at a single managed-care institution.

PATIENTS: Consecutive women undergoing rectal prolapse repair between 2008 and 2016 were included.

INTERVENTIONS: There were no interventions.

MAIN OUTCOME MEASURES: Full-thickness rectal prolapse recurrence was compared between 4 groups: abdominal repair without pelvic organ prolapse (AR−POP); abdominal repair with pelvic organ prolapse (AR+POP); perineal repair without pelvic organ prolapse PR−POP; and perineal repair with pelvic organ prolapse (PR+POP). Recurrence-free period and hazard of recurrence were compared using Kaplan-Meier and Cox proportional hazards methods. To identify potential confounding risk factors for rectal prolapse recurrence, the characteristics of subjects with/without recurrence were compared with univariable and multivariable analyses.

RESULTS: Overall, pelvic organ prolapse was present in 33% of 112 women and was more prevalent among subjects with rectal prolapse recurrence (52.4% vs 28.6%, p = 0.04). Median follow-up was 42.5 months; rectal prolapse recurrence occurred in 18.8% at a median of 9 months. The rate of recurrence and the recurrence-free period differed significantly between groups: AR−POP 3.8%, 95.7 months; AR+POP 13.0%, 86.9 months; PR−POP 34.8%, 42.1 months; PR+POP 57.1%, 23.7 months (p < 0.001). Compared with AR−POP the HR (95% CI) of rectal prolapse recurrence was 3.1 (0.5–18.5) for AR+POP; 14.7 (3.0–72.9) for PR−POP and 31.1 (6.2–154.5) for PR+POP. Compared with AR+POP, PR+POP had a shorter recurrence-free period (p < 0.001) and a higher hazard of recurrence (HR, 10.2; 95% CI, 2.1–49.3).

LIMITATIONS: The retrospective design was a limitation of this study.

CONCLUSIONS: Pelvic organ prolapse was associated with a higher rectal prolapse recurrence rate and earlier recurrence in women undergoing perineal, but not abdominal, repairs. Multidisciplinary evaluation can facilitate individualized management of women with rectal prolapse. Abdominal repair should be considered in women with concomitant rectal and pelvic organ prolapse. See Video Abstract at http://links.lww.com/DCR/A513.

1 Department of Reproductive Medicine, Division of Female Pelvic Medicine and Reconstructive Surgery, University of California, San Diego, San Diego, California

2 Department of Obstetrics and Gynecology, Division of Urogynecology, Kaiser Permanente, San Diego, California

3 Department of General Surgery, Kaiser Permanente, San Diego, California

Funding/Support: National Institute of Aging Grant #R03AG050951

Financial Disclosures: None reported.

Poster presentation at the meeting of the American Urogynecologic Society, Denver, CO, September 27 to October 2, 2016.

Correspondence: Marianna Alperin, M.D., M.S., University of California, San Diego, 9500 Gilman Dr, MC 0863, La Jolla, CA 92093-0863. E-mail malperin@ucsd.edu

© 2018 The American Society of Colon and Rectal Surgeons