Background
There is a growing interest in combined pelvic organ prolapse and rectal prolapse
surgery for concomitant pelvic floor prolapse despite a paucity of data regarding
complications and clinical outcomes of combined repair.
Objective
The primary objective of this study was to compare the <30-day postoperative complication
rate in women undergoing combined POP + RP surgery with that of women undergoing pelvic
organ prolapse–only surgery. The secondary objectives were to describe the <30-day
postoperative complications, compare the pelvic organ prolapse recurrence between
the 2 groups, and determine the preoperative predictors of <30-day postoperative complications
and predictors of pelvic organ prolapse recurrence.
Study Design
This was a multicenter, retrospective cohort study at 5 academic hospitals. Patients
undergoing combined pelvic organ prolapse and rectal prolapse surgery were matched
by age, pelvic organ prolapse stage by leading compartment, and pelvic organ prolapse
procedure compared with those undergoing pelvic organ prolapse–only surgery from March
2003 to March 2020. The primary outcome measure was <30-day complications separated
into Clavien-Dindo classes. The secondary outcome measures were (1) subsequent pelvic
organ prolapse surgeries and (2) pelvic organ prolapse recurrence, defined as patients
who complained of vaginal bulge symptoms postoperatively.
Results
Overall, 204 women underwent combined surgery for pelvic organ prolapse and rectal
prolapse, and 204 women underwent surgery for pelvic organ prolapse only. The average
age (59.3±1.0 vs 59.0±1.0) and mean parity (2.3±1.5 vs 2.6±1.8) were similar in each
group. Of note, 109 (26.7%) patients had at least one <30-day postoperative complication.
The proportion of patients who had a complication in the combined surgery group and
pelvic organ prolapse–only surgery group was similar (27.5% vs 26.0%; P=.82). The Clavien-Dindo scores were similar between the groups (grade I, 10.3% vs
9.3%; grade II, 11.8% vs 12.3%; grade III, 3.9% vs 4.4%; grade IV, 1.0% vs 0%; grade
V, 0.5% vs 0%). Patients undergoing combined surgery were less likely to develop postoperative
urinary tract infections and urinary retention but were more likely to be treated
for wound infections and pelvic abscesses than patients undergoing pelvic organ prolapse–only
surgery. After adjusting for combined surgery vs pelvic organ prolapse–only surgery
and parity, patients who had anti-incontinence procedures (adjusted odds ratio, 1.85;
95% confidence interval, 1.16–2.94; P=.02) and perineorrhaphies (adjusted odds ratio, 1.68; 95% confidence interval, 1.05–2.70;
P=.02) were more likely to have <30-day postoperative complications. Of note, 12 patients
in the combined surgery group and 15 patients in the pelvic organ prolapse–only surgery
group had subsequent pelvic organ prolapse repairs (5.9% vs 7.4%; P=.26). In the combined surgery group, 10 patients (4.9%) underwent 1 repair, and 2
patients (1.0%) underwent 2 repairs. All patients who had recurrent pelvic organ prolapse
surgery in the pelvic organ prolapse–only surgery group had 1 subsequent pelvic organ
prolapse repair. Of note, 21 patients in the combined surgery group and 28 patients
in the pelvic organ prolapse–only surgery group reported recurrent pelvic organ prolapse
(10.3% vs 13.7%; P=.26). On multivariable analysis adjusted for number of previous pelvic organ prolapse
repairs, combined surgery vs pelvic organ prolapse–only surgery, and perineorrhaphy
at the time of surgery, patients were more likely to have a subsequent pelvic organ
prolapse surgery if they had had ≥2 previous pelvic organ prolapse repairs (adjusted
odds ratio, 6.06; 95% confidence interval, 2.10–17.5; P=.01). The average follow-up times were 307.2±31.5 days for the combined surgery cohort
and 487.7±49.9 days for the pelvic organ prolapse–only surgery cohort. Survival curves
indicated that the median time to recurrence was not statistically significant (log-rank,
P=.265) between the combined surgery group (4.2±0.4 years) and the pelvic organ prolapse–only
surgery group (5.6±0.4 years).
Conclusion
In this retrospective cohort study, patients undergoing combined pelvic organ prolapse
and rectal prolapse surgery had a similar risk of <30-day postoperative complications
compared with patients undergoing pelvic organ prolapse–only surgery. Furthermore,
patients who underwent combined surgery had a similar risk of recurrent pelvic organ
prolapse and subsequent pelvic organ prolapse surgery compared with patients who underwent
pelvic organ prolapse–only surgery.
Key words
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Article info
Publication history
Published online: May 30, 2022
Accepted:
May 24,
2022
Received in revised form:
May 20,
2022
Received:
January 9,
2022
Footnotes
E.R.S. reports grant funding to Stanford University from the National Institutes of Health, Foundation for Female Health Awareness, Cook MyoSite Inc, Coloplast, ACell, and Cynosure. E.R.S. owns stock in Pelvalon and received travel reimbursement from Contura.
The other authors report no conflict of interest.
This study was funded by the American Urogynecologic Society and Society of Gynecologic Surgeons Fellows Pelvic Research Network.
Cite this article as: Wallace SL, Kim Y, Lai E, et al. Postoperative complications and pelvic organ prolapse recurrence following combined pelvic organ prolapse and rectal prolapse surgery compared to pelvic organ prolapse–only surgery. Am J Obstet Gynecol 2022;227:317.e1-12.
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