Functional Outcomes Following Combined Zacharin’s Pelvic floor Repair and Rectopexy for Pelvic Prolapse

Abstract

Background: Recurrent and large pelvic prolapses are difficult management problems. Satisfactory anatomical correction while maintaining sexual, urinary and bowel function with minimal recurrences remains a challenge. Because of generalized tissue laxity, some may also have co-existing rectal prolapse. It has been our practice to offer Zacharin's procedure (sacrocolpopexy and levatorplasty) and rectopexy to these patients. The aim of this study was to assess patient satisfaction and functional outcome following combined Zacharin's procedure and rectopexy for recurrent or large apical and posterior compartment prolapse. Methods: Consecutive patients who underwent Zacharin's procedure and rectopexy between 2000 and 2004 were recruited. Hospital records were reviewed. Patient satisfaction was assessed using discrete adjunctival scale. Quality of life (QOL) and functional outcome was assessed using P-QOL and PAC SYM questionnaires and scored according to the respective manuals. Result: There were 58 patients with a mean age of 64 (46-79) years. Mean follow up was 3.8 years. 43 (74%) patients had recurrent apical prolapse and 15 (26%) had large primary prolapse. 20 (35%) patients had overt external rectal prolapse and 38 (65%) had rectal intussusception on defaecating procotogram. 42 (72%) completed questionnaires were returned. Overall, 84% of patients were satisfied with the outcome of their surgery. Ten patients developed de novo stress incontinence requiring further intervention. Pre-operatively, 53 (91%) women had urinary symptoms and 54 (93%) had bowel symptoms. Post-operatively, 21 and 24 women had ongoing urinary and bowel symptoms respectively (c2, P < 0.001). Although the proportion of patients with constipation has improved, the severity of constipation in those with ongoing constipation seemed worse. There were four recurrences over the study period. Conclusion: Zacharin's procedure with rectopexy offers patients a durable repair with good patient reported satisfaction. However, the benefits of this procedure has to be balanced against the potential for troublesome constipation. Patients need to be counseled appropriately prior to the procedure.