Science and Research

Changes in Dynamic Pelvic Floor Magnet Resonance Imaging and Patient Satisfaction after Resection Rectopexy for Obstructed Defecation Syndrome

PURPOSE: Resection rectopexy (RR) provides good functional results and low recurrence rates for the treatment of obstructed defecation syndrome based on rectal prolapse and cul-de-sac syndrome, whereas little is known about changes in pelvic floor dynamics and patient satisfaction after surgery. MATERIALS AND METHODS: Within three years 26 consecutive female patients were prospectively included. Indications for RR (22 laparoscopic, 3 primary open and 1 converted-to-open) were rectal prolapse III degrees in 11 patients and cul-de-sac syndrome in 15 patients. Patients' quality of life (QOL), fecal behavior and defecation-associated pain were investigated before and after surgical treatment using anamnesis and clinical examination, Rand 36-idem health survey (SF-36), Cleveland-Clinic Incontinence Score (CCIS) and the visual analog scale for defecation-associated pain (VAS). Dynamic pelvic floor magnet resonance imaging (dPF-MRI) was used for the investigation of changes in pelvic floor anatomy and function before and after surgery. RESULTS: RR improved the rate of fecal incontinence (p < 0.01) and CCIS (p = 0.01). The use of laxatives (p = 0.01), the need for self-digitation (p = 0.02) and VAS (p < 0.01) were decreased, leading to improvements in QOL (overall p < 0.01). RR led to shortening of the H-line but not of the M-line under rest (p < 0.01) and during defecation (p = 0.04). A rectocele was co-incident in all patients in dPF-MRI before surgery. RR led to a reduction (p < 0.01) and declined protrusion (p = 0.03) of the rectocele. This results in a decreased rate of cul-de-sac (p < 0.01) and increased rate of complete defecation (p < 0.01) after surgery. At the 36-month follow-up no recurrence was observed. CONCLUSION: RR promises high rates of patient satisfaction and improvement in pelvic floor anatomy in select patients. KEY POINTS: * RR improves the pelvic floor anatomy of patients suffering from ODS. * RR improves the QOL of patients suffering from ODS. * An improvement in pelvic floor anatomy led to an improved QOL. * RR is an adequate treatment for select patients suffering from ODS.
  • Reichert, M.; Busse, A.; Hecker, A.; Askevold, I.; Kampschulte, M.; Wusten, O.; Krombach, G. A.; Schwandner, T.; Padberg, W.


  • Adult
  • Aged
  • Defecation/*physiology
  • Female
  • Humans
  • Magnetic Resonance Imaging/*methods
  • Middle Aged
  • *Patient Satisfaction
  • Pelvic Floor/*physiopathology/*surgery
  • Pelvic Floor Disorders/*physiopathology/*surgery
  • Postoperative Complications/*diagnosis/*physiopathology
  • Quality of Life
  • Rectum/*physiopathology/*surgery
  • Syndrome
Publication details
DOI: 10.1055/s-0041-105406
Journal: RoFo : Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin
Pages: 38-44 
Number: 1
Work Type: Original
Location: UGMLC
Disease Area: PLI
Partner / Member: JLU
Access-Number: 26327668
See publication on PubMed

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