Long-Term Outcomes of Transvaginal Sacrospinous Ligament Suture Rectopexy

Obstructed defecation syndrome (ODS) is characterized by a combination of straining, incomplete evacuation, and the use of digital manipulation with defecation. Transvaginal sacrospinous ligament suture rectopexy has been shown to effectively improve obstructed defecation symptoms caused by rectal partial prolapse and lack of support during first year postoperatively. This study aimed to investigate the long-term clinical and anatomical outcomes of this novel and minimally invasive surgery.

This longitudinal prospective cohort study was performed at a tertiary, university-affiliated pelvic health clinic. Women who underwent transvaginal sacrospinous rectopexy for treatment of ODS and for whom time since their surgery was at least 12 months were eligible for inclusion. Patients were contacted via telephone and were offered to come for an in-person evaluation, including symptom assessment (ODS symptoms, PFDI-20 and PGI-I questionnaires), POP-Q evaluation, and 3D dynamic ultrasound for assessment of rectal hypermobility. Clinical success was defined as not having any ODS symptoms (straining, incomplete emptying, or need to splint) in over 50% of bowel movements. Anatomical success was defined as not having rectal prolapse and compression ratio on ultrasound assessment of less than 50%.

A total of 135 patients were eligible for inclusion, out of which 65 patients, averaging 63.3 ± 13.3 years in age and 27.1 ± 5.6 in body mass index (BMI), were recruited. Median follow-up time was 29 months. Subjective failure was noted in 18 patients (28.1%) who experienced symptoms in more than 50% of bowel movements. Anatomical failure, defined as having a compression ratio of more than 50% or rectal prolapse, was noted in seven patients (12.7%). Three patients failed treatment with a recurrence of rectal prolapse and two patients underwent ventral mesh rectopexy within 1 year after surgery. Ultrasound measurements revealed that compression ratio significantly reduced from 52.9% ± 24.7 to 17.7% ± 12.3 (p < 0.001), indicating substantial anatomical improvements during the follow-up period.

In conclusion, this study indicates that transvaginal sacrospinous ligament rectopexy is a safe, feasible, and minimally invasive effective alternative for treating ODS.