(Poster 76) Perioperative and Recurrence Outcomes After Combined VMR and SCP for Prolapse

Objectives: Treatment outcomes of women undergoing concomitant ventral mesh rectopexy (VMR) and sacrocolpopexy (SCP) for concurrent rectal prolapse (RP) and pelvic organ prolapse (POP) are not well described. Our primary objective was to assess recurrence rates of RP and POP following combined abdominal mesh repair and identify preoperative predictors of recurrence. Secondary objectives included evaluation of perioperative outcomes, including intraoperative complications, 30-day readmissions, unplanned clinical or electronic medical record (EMR) encounters, and postoperative complications.

Methods: We conducted a retrospective cohort study of women ≥18 years who underwent concurrent abdominal RP and POP surgery at a high-volume tertiary care center between 2020 and 2021. All patients underwent VMR with either mesh-based vaginal colpopexy or hysteropexy. Postoperative complications were classified using the Clavien-Dindo (CD) system. Prolapse recurrence was defined as mucosal rectal prolapse, full-thickness rectal prolapse, or Stage 2 vaginal prolapse in any compartment on physical exam.

Results: Seventy-five patients underwent combined RP and POP repair. Forty-four (58.7%) had a prior hysterectomy, 15 (20.0%) had prior vaginal prolapse surgery (3 with abdominal mesh), and 16 (21.3%) had prior rectal prolapse repair (2 with abdominal mesh). Seventy-four cases were robotic; one was open. Synthetic mesh was used in 74 cases; biologic in one. Sacral fixation used non-absorbable sutures in 73 cases and absorbable in two. Concurrent procedures included supracervical hysterectomy (n=26), total hysterectomy (n=2), and mid-urethral sling placement (n=24). There were two intraoperative complications, vaginotomy and cystotomy. Thirty-three patients (44.0%) were discharged home same day; 38 (50.0%) on postoperative day one. Postoperative healthcare utilization was low; mean 2 .0+/-2.1EMR encounters.

Eight patients (10.7%) had unplanned office visits, 5 (6.7%) presented to the emergency department, and 3 (4.0%) were readmitted within 30 days. Twelve patients (16.0%) had complications: 2 CD Grade I, 11 CD Grade II (7 UTIs requiring antibiotics), 1 CD Grade IIIa (chest tube for pneumothorax), and 1 CD Grade IIIb (bowel resection for small bowel injury). At a mean follow-up of 391 ± 464.7 days, 11 patients (14.6%) had prolapse recurrence 3 with rectal mucosal prolapse, 5 with full-thickness RP (FTRP), 2 with both FTRP and Stage 2 anterior/posterior vaginal prolapse, and 1 with isolated Stage 2 posterior vaginal prolapse. Mean time to recurrence was 459.5 ± 411 days. Five patients underwent reoperation: 3 open suture rectopexies, 1 repeat robotic VMR, and 1 repeat VMR + SCP. Longer operative time was significantly associated with recurrence (p-0.004).

Conclusions: Concurrent VMR and SCP is a feasible and safe approach for multicompartment prolapse, with acceptable perioperative morbidity and low short-term recurrence. Longer operative time may be associated with increased risk of recurrence.