Development of Rectal Prolapse After Surgical Management of Pelvic Organ Prolapse: Obliterative Versus Reconstructive

Pelvic organ prolapse (POP) is a common condition among aging women, whereas rectal prolapse (RP) is uncommon. The change of anatomy and vector of downward force after surgical repair of POP may be a risk factor for RP. The objective of this study is to examine the occurrence of RP after surgical repair of POP and associated clinical factors.

A retrospective chart review was performed from 2013 to 2024 for women who had undergone surgery for POP at a single institution. Demographic variables were analyzed. Correct diagnoses were validated, and clinical courses were extracted. Appropriate statistical analysis was performed.

A total of 2381 surgeries for POP were performed (2150 reconstructive, 231 obliterative). Seven patients developed RP, 0.14% of patients who had undergone reconstructive surgery, and 1.7% in whom obliterative vaginal surgery had been performed. In univariate analysis, the odds of a patient being diagnosed with RP after reconstructive repair were 12 times lower than after an obliterative repair (OR 0.08, CI 0.012-0.48, p < 0.05). After adjusting for age, parity, and BMI, patients who had undergone obliterative surgical repair still showed higher odds of developing RP than those who had undergone reconstructive repair, although this finding did not reach statistical significance (OR 6.15, 95% CI 0.76-44.84, p = 0.09).

This exploratory description of the finding of RP in patients who had undergone surgical repair of POP generates the hypothesis that there is a higher likelihood of the developing RP in patients who undergo obliterative vaginal repairs than in those who undergo reconstructive vaginal repairs. Further research is needed to elucidate this relationship.