Modified anterior rectopexy – clinical and radiological outcomes in patients with combined defects in the posterior pelvic compartment

Background Different types of posterior pelvic organ prolapse (PPOP; rectal prolapse, rectocele or enterocele) often coexist and can be associated with overlapping symptoms. This study introduces a modified laparoscopic anterior rectopexy, laparoscopic vaginorectopexy (LVRP), for the correction of multiple PPOP in a single procedure. The focus is on bowel function, recurrence rates and complications. Methods Twenty-five women with symptoms of obstructed defecation (OD) and more than one PPOP were prospectively included and assessed with clinical examination, defecography and a questionnaire for bowel function and quality of life (QoL). During LVRP, a t-shaped mesh was sutured to the pelvic muscles, vagina and sacrouterine ligaments and then stapled to the promontory; the mesorectum was stapled to the mesh. Follow up was scheduled twelve months after the procedure and long term (minimum ten years). Results One patient suffered from mesh erosion and another from postoperative bleeding. Outcomes after twelve months were: no recurrence of internal or external rectal prolapse; three rectoceles and one enterocele recurred; bowel function and QoL improved for around half of patients; few patients deteriorated. At long term follow up, the effects on OD and QoL were unchanged, but an increase in incontinence was recorded. Conclusions LVRP is a technique for the correction of multiple PPOP in a single procedure. The procedure is safe with low recurrence and complication rates. Bowel function and QoL improve over the short term, while the effect on faecal incontinence deteriorates over the long term. Trial registration no.: NCT06330857