Improved Bowel Function With Robotic Sacrocolpopexy for Pelvic Organ Prolapse

Lara C. Pullen, PhD

October 05, 2012

October 5, 2012 (Chicago, Illinois) — Robotic sacrocolpopexy for symptomatic pelvic organ prolapse (POP) results in most patients reporting "improved" or "unchanged" bowel function, according to a new study.

Christa M. Lewis, DO, of Atlantic Health System, Morristown, New Jersey, presented the results of her single-center prospective study in a poster session at the American Urogynecologic Society (AUGS) 33rd Annual Scientific Meeting. The study was designed to assess the change in bowel function associated with robotic sacrocolpopexy for symptomatic POP.

Sacrocolpopexy is the "gold standard" for apical prolapsed repair, the study's researchers note. Previous studies have demonstrated excellent long-term anatomical results. Success was initially only defined by anatomical outcomes, but quality-of-life measures have now improved overall patient care and counseling, they said.

More recently, minimally invasive techniques such as laparoscopy and robotics have improved the ability to perform sacrocolpopexy with excellent outcomes. Few previous studies, however, have examined bowel function post-sacrocolpopexy.

The procedure was performed with the posterior graft arm extending all the way down the perineum. Although some patients did report worsened symptoms, including de novo splinting, their overall symptom bother was low.

The study included 423 patients between January 2007 and August 2011. Data included validated bowel function questionnaires, demographic information, and detailed urogynecologic history, all of which were collected at baseline, 6 months, and 12 months postoperatively.

Two primary outcomes were evaluated: scores on the Colorectal-Anal Distress Inventory, Short Form 8 (CRADI-8), to assess the degree of bother from obstructive bowel symptoms, anal incontinence, pain, or rectal prolapse, and the Colorectal-Anal Impact Questionnaire Short Form 7 (CRAIQ-7), to assess the impact of bowel symptoms on quality of life. The secondary outcome measure was splinting for defecation.

The authors created 3 groups: improved, unchanged, and worsened, using the difference between the baseline and 12-month CRADI-8 scores. Chi-square, student's t tests, and ANOVA were used for statistical analysis.

The study reported 12-month follow-up data for 393 patients (93%).

The authors found that mean CRADI-8 scores improved significantly from 21.1 ± 20 at baseline to 8.3 ± 12 at 6 months (P < .0001) and 7.2 ± 11 at 12 months (P < .0001). CRAIQ-7 scores also improved significantly from 11.1 ± 20 at baseline to 3.7 ± 13 at 6 months (P < .0001) and 3.1 ± 11 at 12 months (P < .0001).

Larry Bowen, MD, of Sutter Roseville Medical Center in Sacramento, California, commented to Medscape Medical News: "It showed that they eliminated the symptoms in most people without creating new problems." He added, "You are never going to cure everyone. Some people are going to get worse."

He explained that one of the study's strengths was that they had a large number of patients with a common condition. He also emphasized that they extended their mesh down to the posterior vagina.

In her presentation, Dr. Lewis acknowledged that not everyone saw improvement, "So basically, patients with significant bowel symptoms at baseline saw improvement." Specifically, 71% of splinters had complete remission.

Preoperatively, 39% of patients reported splinting using their fingers to push on the vagina or perineum to complete a bowel movement. The study found no correlation between splinting and degree of preoperative posterior compartment prolapsed. The splinters had significantly worse baseline CRADI-8 scores than the nonsplinters (P < .0001).

In contrast, 8% of patients who were nonsplinters before surgery reported de novo splinting at 12 months. The patients had mean CRADI-8 scores of 13.2 ± 9 at 12 months, suggesting that they were experiencing a low degree of bother.

Dr. Bowen and Dr. Lewis have disclosed no relevant financial relationships.

American Urogynecologic Society (AUGS) 33rd Annual Scientific Meeting: Oral Poster 4. Presented October 4, 2012.