Introduction Laparoscopic ventral mesh rectopexy (LVMR) is becoming ever more widely used in the management of rectal prolapse, intussusception and obstructive defecation syndrome (ODS). It is widely accepted that previous gynaecological surgery, and hysterectomy in particular, predispose women to developing pelvic floor dysfunction. It is unclear whether such interventions have any impact on the efficacy of LVMR in terms of symptom resolution or quality of life. We aimed to investigate whether there is any negative effect on quality of life post-LVMR that is attributable to gynaecological surgical history.
Method We investigated a prospectively collected database maintained by a single pelvic floor surgeon with expertise in LVMR. We compared women with a history of gynaecological surgery against those who had never undergone any form of abdominal or pelvic operative procedure. Data were collected on patient demographics, surgical history, intra-operative details, and quality of life (QoL) and bowel function. This included pre- and post-operative ODS scoring. QoL was assessed via the validated Birmingham Bowel and Urinary Symptoms Questionnaire-22 (BBUSQ-22) and was collected up to a maximum of 8 years after LVMR.
Results From a database of over 1000 LVMR patients there were 439 women who had previously undergone gynaecological surgery and 271 with no abdominal or pelvic surgical history of any sort. Median age in the gynaecology surgery group (GS) was 53 (IQR 43–65) and 63 (54–72) in the non-surgical group (NS). Mean pre-op ODS scores were 19.6 (NS) and 19.3 (GS) and fell to 8.1 and 8.5 respectively. These figures represent percentage improvements of 59% and 56%.
The trend in QoL score pre-LVMR and through 8 years of follow-up is shown in the Table 1:
At 8 years there was a 40% QoL improvement in the NS group and a 39% improvement in the GS group. There were no statistically significant differences in function or QoL score between the groups at any point during the study.
Conclusion LVMR is equally efficacious in treating a range of pelvic floor pathology in patients who have previously undergone gynaecological surgery compared to women who have no history of abdominal or pelvic surgical procedures. Sustained functional and QoL benefits are seen post-operatively in both groups with no statistical difference in percentage improvement.
Disclosure of interest None Declared.
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