The influence of sacrocolporectopexy on pelvic anatomy assessed in an upright position using MRI

IF 2.9 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Colorectal Disease Pub Date : 2025-05-07 DOI:10.1111/codi.70114

Mart C. P. Kortman, Jan W. P. Vanstiphout, Akeel Alhafidh, Frank F. J. Simonis, Anique T. M. Grob

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Abstract

Aim

Rectopexy with concomitant sacrocolpopexy (sacrocolporectopexy) is the favoured technique for treating combined pelvic organ prolapse and internal or external rectal prolapse, despite limited functional improvement. Previous studies have assessed anatomical change after standalone rectopexy or sacrocolpopexy, based on supine MRI defaecography. Since a supine position can underestimate the extent of pelvic organ prolapse, it might also incorrectly assess the anatomical effect of sacrocolporectopexy. The aim of this study was to assess the effect of sacrocolporectopexy on the pelvic anatomy in an upright position.

Method

Twenty one female patients undergoing sacrocolporectopexy from December 2022 to June 2024 were included. All patients underwent physical examination and MRI defaecography preoperatively and postoperatively. The descent of the bladder, vaginal vault and anorectal junction and the size of the rectocele and enterocele were assessed on the MRI defaecography images during maximum straining. Significance was tested using a paired t-test and an improvement of ≥10 mm was considered clinically relevant. The results were compared with previous studies, which used supine assessment.

Results

Postoperative improvement was found for the bladder, vaginal vault, anorectal junction, rectocele and enterocele with 14, 44, 5, 16 and 54 mm respectively. The bladder, vaginal vault, rectocele and enterocele showed clinically relevant improvement. Compared with supine results, upright assessments revealed a larger organ lift for the vaginal vault as well as a higher, overall, position of the anorectal junction.

Conclusion

Upright assessment of sacrocolporectopexy differs from supine assessment, with statistical and clinically relevant lift for the pelvic organs.

Abstract Image

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骶直肠固定术对直立体位骨盆解剖的影响

目的直肠固定术合并骶colporectopexy（骶colporectopexy）是治疗合并盆腔器官脱垂和内外直肠脱垂的首选技术，尽管功能改善有限。先前的研究基于仰卧位MRI缺陷成像评估了独立直肠固定术或骶髋固定术后的解剖变化。由于仰卧位可能低估盆腔器官脱垂的程度，因此也可能错误地评估骶结肠直肠固定术的解剖学效果。本研究的目的是评估骶直肠固定术对直立位置骨盆解剖的影响。方法选取2022年12月至2024年6月行骶直肠切除术的女性患者21例。所有患者术前、术后均行体格检查和MRI造影检查。在最大张力下，通过MRI缺陷成像评估膀胱、阴道穹窿和肛肠交界处的下降以及直肠膨出和小肠膨出的大小。采用配对t检验检验显著性，改善≥10 mm被认为具有临床相关性。结果与先前使用仰卧位评估的研究进行了比较。结果术后膀胱、阴道穹窿、肛肠结、直肠膨出、小肠膨出分别改善14、44、5、16、54 mm。膀胱、阴道穹窿、直肠膨出、肠膨出均有明显改善。与仰卧位的结果相比，直立评估显示阴道穹窿的器官提升更大，总体而言，肛门直肠连接处的位置也更高。结论骶结肠固定术直立评估与仰卧评估不同，盆腔脏器有统计学和临床相关的提升。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Colorectal Disease 医学-胃肠肝病学

CiteScore

6.10

自引率

11.80%

发文量

406

审稿时长

1.5 months

期刊介绍： Diseases of the colon and rectum are common and offer a number of exciting challenges. Clinical, diagnostic and basic science research is expanding rapidly. There is increasing demand from purchasers of health care and patients for clinicians to keep abreast of the latest research and developments, and to translate these into routine practice. Technological advances in diagnosis, surgical technique, new pharmaceuticals, molecular genetics and other basic sciences have transformed many aspects of how these diseases are managed. Such progress will accelerate. Colorectal Disease offers a real benefit to subscribers and authors. It is first and foremost a vehicle for publishing original research relating to the demanding, rapidly expanding field of colorectal diseases. Essential for surgeons, pathologists, oncologists, gastroenterologists and health professionals caring for patients with a disease of the lower GI tract, Colorectal Disease furthers education and inter-professional development by including regular review articles and discussions of current controversies. Note that the journal does not usually accept paediatric surgical papers.