Outcomes of Combined Ventral Rectopexy and Sacrocolpo/Hysteropexy for Multicompartment POP

Overview

This systematic review and meta-analysis evaluated the anatomical and functional outcomes of combined ventral rectopexy and sacrocolpo/hysteropexy in treating multicompartment pelvic organ prolapse (POP). The combined minimally invasive approach demonstrated significant improvements in anatomical correction and symptom relief, with acceptable complication and reoperation rates.

Background

Pelvic organ prolapse (POP) involves descent of vaginal compartments due to pelvic floor support defects, affecting approximately 24% of women and increasing with age. Multicompartmental prolapse often presents with coexisting urogenital and rectal symptoms such as urinary incontinence, obstructed defecation syndrome, and fecal incontinence. Surgical repair is indicated in 11–20% of cases, with up to 30% requiring reoperation. Combined ventral rectopexy and sacrocolpopexy address posterior and anterior/apical defects simultaneously, leveraging similar pelvic dissections and minimally invasive techniques to improve outcomes.

Data Highlights

Key Findings

• Combined laparoscopic or robotic ventral rectopexy and sacrocolpo/hysteropexy effectively correct multicompartment POP with improved anatomical outcomes.
• Functional symptoms including obstructed defecation syndrome and anal/fecal incontinence showed significant postoperative improvement.
• Subjective recurrence of prolapse symptoms was reduced following the combined surgical approach.
• The minimally invasive combined procedure demonstrated acceptable safety profiles with low rates of serious complications.
• Reoperation rates remained relatively low, supporting durability of the combined repair.
• Similar pelvic dissections in both procedures facilitate safe simultaneous performance, optimizing recovery and outcomes.

Clinical Implications

Clinicians should consider combined ventral rectopexy and sacrocolpo/hysteropexy for patients presenting with multicompartment POP to address both anterior/apical and posterior defects simultaneously. The minimally invasive approach offers improved anatomical and functional results with low complication and reoperation rates, enhancing patient quality of life. Multidisciplinary collaboration is essential for optimal surgical planning and management.

Conclusion

The combined minimally invasive approach of ventral rectopexy and sacrocolpo/hysteropexy provides effective anatomical correction and functional symptom relief in multicompartment pelvic organ prolapse, with favorable safety and durability profiles. This evidence supports its use as a comprehensive surgical strategy in appropriately selected patients.

References

1. D’Hoore et al. -- Laparoscopic Ventral Mesh Rectopexy
2. PRISMA 2020 Guidelines -- Systematic Review Reporting Standards
3. ROBINS-I Tool -- Risk of Bias in Non-Randomized Studies