EP333 - Factors Associated with Persistent Constipation After Combined Sacrocolpopexy and Suture Rectopexy

Sunday, May 11, 2025

8:32 AM – 8:37 AM PT

Location: Monitor 8. Sails Pavilion, Upper Level

ePoster Presenter(s)

SV

Sudheer Vemuru, MD

Resident
University of Colorado School of Medicine, Department of Surgery
Aurora, Colorado, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

Samuel H. Lai, MD

Resident
University of Colorado School of Medicine, Department of Surgery
University of Colorado School of Medicine
Aurora, CO, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
Janet S. Lee, MD

Resident physician
University of Colorado
Aurora, CO, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
KC

Kathleen Connell, MD

Professor
University of Colorado School of Medicine, Department of Obstetrics and Gynecology
Aurora, Colorado, United States

Disclosure information not submitted.
LR

Lauren Rascoff, MD

Assistant Professor
University of Colorado School of Medicine, Department of Obstetrics and Gynecology
Aurora, Colorado, United States

Disclosure information not submitted.
MG

Marsha Guess, MD, MS

Professor
University of Colorado School of Medicine, Department of Obstetrics and Gynecology
Aurora, Colorado, United States

Disclosure information not submitted.
MM

Michael S. McNevin, MD

Associate Professor of Surgery
University of Colorado School of Medicine
Denver, Colorado, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
EB

Elisa Birnbaum, MD

Professor of Surgery
University of Colorado School of Medicine
university of colorado
Denver, Colorado, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Senior Author(s)

AM

Amber Moyer, MD

Assistant Professor of Surgery
University of Colorado School of Medicine
Denver, Colorado, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.

Sudheer Vemuru, MD: This individual has no financial relationships with ineligible companies.

Samuel H. Lai, MD: This individual has no financial relationships with ineligible companies.

Janet S. Lee, MD: This individual has no financial relationships with ineligible companies.

Michael S. McNevin, MD: This individual has no financial relationships with ineligible companies.

Elisa Birnbaum, MD: This individual has no financial relationships with ineligible companies.

Amber Moyer, MD: This individual has no financial relationships with ineligible companies.

Image or Table (Do Not add text here):

Purpose/Background: Pelvic organ prolapse (POP) is common among women and may contribute to defecatory dysfunction. Simultaneous sacrocolpopexy and suture rectopexy has been shown to restore normal anatomy and improve symptoms in patients with POP affecting multiple pelvic compartments. However, a minority of patients continue to experience defecatory dysfunction, and it is unclear what factors may portend poor functional outcomes after surgery. The aim of this study was to compare patients with persistent versus resolved constipation after combined sacrocolpopexy and suture rectopexy.

Methods/Interventions: We performed a retrospective review of adult female patients who underwent combined sacrocolpopexy and suture rectopexy for multicompartment POP at an academic center from January 2019 to September 2021. Patients completed questionnaires querying symptoms prior to and after surgery. Constipation was defined as either patient-reported straining, pain, or incomplete evacuation with bowel movements. Clinical and demographic variables and postoperative outcomes were reviewed. Chi-squared and Fisher’s exact tests were used to compare factors among patients with persistent versus resolved constipation. Odds ratios were generated using a binary logistic regression.

Results/Outcomes: Of 293 patients who underwent combined sacrocolpopexy and suture rectopexy during the study period, 177 (60%) reported preoperative constipation. Of the 177 patients with preoperative constipation, 127 (72%) had resolution of constipation, while 50 (28%) had persistent constipation postoperatively at a mean follow-up of 9 months. Those with and without persistent constipation were similar in age, body mass index, stage of POP, and in terms of proportions with prior pelvic floor repair, preoperative full-thickness rectal prolapse, enterocele, rectal intussusception, rectocele, receipt of minimally invasive repair, receipt of posterior colporrhaphy, receipt of perineorrhaphy, and recurrence of POP. A greater proportion of patients with persistent constipation were premenopausal (34% vs 19%; p=0.047) and had delayed colonic transit (18% vs 4%; p=0.004). A binary logistic regression (Table 1) was fit using POP stage, menopausal status, presence of delayed colonic transit, prior pelvic floor repair, and postoperative recurrence of POP as covariates. Preoperative evidence of delayed colonic transit was associated with persistent constipation (OR 5.15; p=0.007).

Conclusion/Discussion: Combined sacrocolpopexy and suture rectopexy was associated with a high rate of resolution of defecatory dysfunction. However, premenopausal women and those with delayed colonic transit tended to have poorer functional outcomes after surgery. Patients with these risk factors should be counseled on expectations regarding postoperative bowel dysfunction. Evaluation of colonic transit should be considered in the preoperative workup of POP patients with defecatory dysfunction as well as in patients with refractory constipation after sacrocolporectopexy.