Annals of Coloproctology

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Benign proctology

Three-Dimensional Pelvic Floor Ultrasound Assessment of Pelvic Organ Prolapse: Minimal Levator Hiatus and Levator Ani Deficiency Score: Yongwoo Yune, Hong Yoon Jeong, Duk Hoon Park, Jong Kyun Lee; Ann Coloproctol. 2021;37(5):291-297. Published online August 9, 2021; DOI: https://doi.org/10.3393/ac.2020.01095.0156

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Purpose
The purpose of this study was to determine whether levator ani deficiency (LAD) scores and minimal levator hiatus (MLH) areas affect Pelvic Organ Prolapse Quantification (POP-Q) stage.
Methods
This study was a retrospective chart review of patients with pelvic organ prolapse (POP) at Seoul Songdo Hospital between August 2019 and August 2020. Three-dimensional (3D) pelvic floor ultrasound, preoperative anal manometry, and other physiological tests were performed in 78 patients with POP symptoms. We divided the patients into mild prolapse and severe prolapse groups based on the POP-Q. We examined the LAD and MLH areas. LAD scores were categorized as mild, moderate, or severe.
Results
There were 32 patients (41.0%) in the mild prolapse group (POP-Q stage I and II) and 46 (59.0%) in the severe prolapse group (POP-Q stage III and IV). The mean LAD score was significantly higher in severe prolapse group (13.33±2.49 vs. 8.19±2.92, P<0.001), and the rate of severe deficiency was also significantly higher in the severe prolapse group (29 [63.0%] vs. 2 [6.3%], P<0.001). The mean MLH was also significantly larger in the severe prolapse group (17.91±2.74 cm² vs. 14.95±2.60 cm², P<0.001). In addition, both MLH and LAD scores tended to increase at each stage.
Conclusion
There is a strong positive correlation between the POP-Q stage and the MLH and LAD scores that can be seen on 3D pelvic floor ultrasound. The findings of this study, by objectively demonstrating LAD and MLH in women with POP, are an important contribution to POP.

Citations

Citations to this article as recorded by

Pelvic floor dysfunction in patients with gestational diabetes mellitus
Mustafa Arslan, Ramazan Kozan
World Journal of Diabetes.2025;[Epub] CrossRef
The predicting value of the ratio of levator hiatus diameter to fetal head circumference in pregnant women at 37 weeks of gestation in the progression of the second stage of labor and levator ani injury 6 weeks postpartum
Bei Gan, Shan Zheng, Xiuyan Wu, Xuemei Li
Heliyon.2024; 10(4): e25636. CrossRef
Advancements in artificial intelligence for pelvic floor ultrasound analysis
Xinghua Huang
American Journal of Translational Research.2024; 16(4): 1037. CrossRef
Three‐dimensional endovaginal ultrasound assessment using the levator ani deficiency score in primiparas: A replication study
Emilia Rotstein, Vilhelmina Ullemar, Marianne Starck, Gunilla Tegerstedt
Acta Obstetricia et Gynecologica Scandinavica.2023; 102(9): 1236. CrossRef
Correlation between clinical examination and perineal ultrasound in women treated for pelvic organ prolapse
Célia Maheut, Thibaud Vernet, Hugo Le Boité, Hervé Fernandez, Perrine Capmas
Journal of Gynecology Obstetrics and Human Reproduction.2023; 52(9): 102650. CrossRef
Colonic pseudo-obstruction in a patient with dyssynergic defecation: A case report
Yejun Jeong, Yongjae Kim, Wonhyun Kim, Seoyeon Park, Su-Jin Shin, Eun Jung Park
International Journal of Surgery Case Reports.2022; 98: 107524. CrossRef
Is It a Refractory Disease?- Fecal Incontinence; beyond Medication
Chungyeop Lee, Jong Lyul Lee
The Ewha Medical Journal.2022;[Epub] CrossRef

Laparoscopic Vaginal Suspension and Rectopexy for Rectal Prolapse: Shi-Jun Yang, Seo-Gue Yoon, Ki-Yun Lim, Jong-Kyun Lee; Ann Coloproctol. 2017;33(2):64-69. Published online April 28, 2017; DOI: https://doi.org/10.3393/ac.2017.33.2.64

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15 Web of Science
16 Citations

Abstract PDF

Purpose

Laparoscopic procedures for the treatment of patients with a rectal prolapse have gained increasing worldwide acceptance because they have lower recurrence and better functional outcome than perineal procedures. Nevertheless, ideal surgical methods are still not available. We propose a new surgical technique, laparoscopic vaginal suspension and rectopexy, for correcting a full-thickness rectal prolapse and/or middle-compartment prolapse. This study assessed the short-term outcomes for patients who underwent laparoscopic vaginal suspension and rectopexy.

Methods

Between April 2014 and April 2016, 69 female patients underwent laparoscopic vaginal suspension and rectopexy to correct a rectal prolapse. Demographics, medical histories, and surgical and follow-up details were collected from their medical records. In addition to the clinical outcome, we repeated defecation proctography and a questionnaire regarding functional results three months after surgery.

Results

No major morbidities or no mortalities occurred. The defecation proctography confirmed excellent anatomical result in all cases. Of 7 patients with combined middle-compartment prolapses, we observed good anatomical correction. During follow-up, full-thickness recurrence occurred in one patient. Preoperative fecal incontinence was improved significantly at 3 months (mean Wexner score: 12.35 vs. 7.71; mean FISI: 33.29 vs. 21.07; P < 0.001). Analysis of responses to the fecal incontinence quality of life (FIQOL) questionnaire showed overall improvement at 3 months compared to the preoperative baseline (mean pre- and postoperative FIQOL scores: 12.11 vs. 14.39; P < 0.004).

Conclusion

Laparoscopic vaginal suspension and rectopexy is a new combined procedure for the treatment of patients with rectal prolapses. It has excellent functional outcomes and minimal morbidity and can correct and prevent middlecompartment prolapses.

Citations

Citations to this article as recorded by

Surgical outcomes on health-related quality of life in rectal prolapse: A systematic review and meta-analysis
Hannaneh Yousefi-Koma, Yassin Rahnama, Dorsa Najari, Fatemeh Fathabadi, Mojtaba Sedaghat, Alireza Kazemeini, Mohammad Reza Keramati, Amir Keshvari, Mohammad Sadegh Fazeli, Behnam Behboudi, Seyed Mohsen Ahmadi-Tafti
Techniques in Coloproctology.2025;[Epub] CrossRef
Surgical and Functional Outcome of Laparoscopic Vaginal Suspension Combined with Suture Rectopexy for Management of Pelvic Organ Prolapse
Mohamed I. Abuelnasr, Ahmed M. F. Salama, Ahmed M. Nawar
Journal of Coloproctology.2024; 44(01): e1. CrossRef
Mesh-associated complications in minimally invasive ventral mesh rectopexy: a systematic review
Gabriel Fridolin Hess, Fabio Nocera, Stephanie Taha-Mehlitz, Sebastian Christen, Marco von Strauss Und Torney, Daniel C. Steinemann
Surgical Endoscopy.2024; 38(12): 7073. CrossRef
Modified robotic ventral rectopexy with folded single titanized mesh suspension for the treatment of complex pelvic organ prolapse
Bernardina Fabiani, Alessandro Sturiale, Lisa Fralleone, Claudia Menconi, Vittorio d'Adamo, Gabriele Naldini
Colorectal Disease.2023; 25(3): 453. CrossRef
Natural Orifice Transanal Endoscopic Rectopexy for Complete Rectal Prolapse: Prospective Evolution of a New Technique and Short-term Outcomes
Abhijit Chandra, Pritheesh Rajan, Vivek Gupta, Saket Kumar, Mahesh Rajashekhara, Ravi Patel, Bharat Sangal, Vikram Singh
Diseases of the Colon & Rectum.2023; 66(1): 118. CrossRef
Assessment of feasibility of abdominal mesh vaginorectopexy in the repair of multiple pelvic organ prolapse
Mohamed Mazloum Zakareya, Walid Galal Elshazly, Ahmed Mohamed Moaz, Bassem Khamis Hegazy
Alexandria Journal of Medicine.2023; 59(1): 15. CrossRef
A quantitative study to explore functional outcomes following laparoscopic ventral mesh rectopexy for rectal prolapse
O Olatunbode, S Rangarajan, V Russell, YKS Viswanath, A Reddy
The Annals of The Royal College of Surgeons of England.2022; 104(6): 449. CrossRef
Postoperative complications and pelvic organ prolapse recurrence following combined pelvic organ prolapse and rectal prolapse surgery compared with pelvic organ prolapse only surgery
Shannon L. Wallace, Youngwu Kim, Erica Lai, Shailja Mehta, Bertille Gaigbe-Togbe, Chiyuan Amy Zhang, Emily C. Von Bargen, Eric R. Sokol
American Journal of Obstetrics and Gynecology.2022; 227(2): 317.e1. CrossRef
A Collaborative Approach to Multicompartment Pelvic Organ Prolapse
Brooke Gurland, Kavita Mishra
Clinics in Colon and Rectal Surgery.2021; 34(01): 069. CrossRef
Postoperative complications and recurrence rates after rectal prolapse surgery versus combined rectal prolapse and pelvic organ prolapse surgery
Shannon L. Wallace, Ekene A. Enemchukwu, Kavita Mishra, Leila Neshatian, Bertha Chen, Lisa Rogo-Gupta, Eric R. Sokol, Brooke H. Gurland
International Urogynecology Journal.2021; 32(9): 2401. CrossRef
European Society of Coloproctology guidance on the use of mesh in the pelvis in colorectal surgery
Yasuko Maeda, Eloy Espin‐Basany, Kim Gorissen, Mia Kim, Paul‐Antoine Lehur, Lilli Lundby, Ionut Negoi, Gregor Norcic, P. Ronan O’Connell, Tero Rautio, Bart van Geluwe, Gabrielle H. van Ramshorst, Andrea Warwick, Carolynne J. Vaizey
Colorectal Disease.2021; 23(9): 2228. CrossRef
Transvaginal rectopexy using the Flex® Colorectal Drive Robotic System: a proof-of-concept approach to rectal prolapse
J. O. Paull, A. Graham, S. Parascandola, S. Hota, S. Stein, B. Umapathi, A. Abdullah, N. Pudalov, V. Obias
Techniques in Coloproctology.2020; 24(5): 471. CrossRef
Clinical efficacy of integral theory–guided laparoscopic integral pelvic floor/ligament repair in the treatment of internal rectal prolapse in females
Yang Yang, Yong-Li Cao, Yuan-Yao Zhang, Shou-Sen Shi, Wei-Wei Yang, Nan Zhao, Bing-Bing Lyu, Wen-Li Zhang, Dong Wei
World Journal of Clinical Cases.2020; 8(23): 5873. CrossRef
Clinical efficacy of integral theory–guided laparoscopic integral pelvic floor/ligament repair in the treatment of internal rectal prolapse in females
Yang Yang, Yong-Li Cao, Yuan-Yao Zhang, Shou-Sen Shi, Wei-Wei Yang, Nan Zhao, Bing-Bing Lyu, Wen-Li Zhang, Dong Wei
World Journal of Clinical Cases.2020; 8(23): 5876. CrossRef
Clinical Outcome and Surgical Technique of Laparoscopic Posterior Rectopexy Using the Mesh With Anti-adhesion Coating
Yasunori Matsuda, Masahiro Nishikawa, Satoshi Nishizawa, Yoshinori Yane, Hokuto Ushijima, Taigo Tokuhara
Surgical Laparoscopy, Endoscopy & Percutaneous Techniques.2019; 29(4): e41. CrossRef
Comparison of Delorme-Thiersch Operation Outcomes in Men and Women With Rectal Prolapse
Keehoon Hyun, Seo-Gue Yoon
Annals of Coloproctology.2019; 35(5): 262. CrossRef

Review

Vaginal Approaches Using Synthetic Mesh to Treat Pelvic Organ Prolapse: Jei Won Moon, Hee Dong Chae; Ann Coloproctol. 2016;32(1):7-11. Published online February 29, 2016; DOI: https://doi.org/10.3393/ac.2016.32.1.7

7,828 View
52 Download
7 Web of Science
5 Citations

Abstract PDF

Pelvic organ prolapse (POP) is a very common condition in elderly women. In women with POP, a sacrocolpopexy or a vaginal hysterectomy with anterior and posterior colporrhaphy has long been considered as the gold standard of treatment. However, in recent decades, the tendency to use a vaginal approach with mesh for POP surgery has been increasing. A vaginal approach using mesh has many advantages, such as its being less invasive than an abdominal approach and easier to do than a laparoscopic approach and its having a lower recurrence rate than a traditional approach. However, the advantages of a vaginal approach with mesh for POP surgery must be weighed against the disadvantages. Specific complications that have been reported when using mesh in POP procedures are mesh erosion, dyspareunia, hematomas, urinary incontinence and so on, and evidence supporting the use of transvaginal surgery with mesh is still lacking. Hence, surgeons should understand the details of the surgical pelvic anatomy, the various surgical techniques for POP surgery, including using mesh, and the possible side effects of using mesh.

Citations

Citations to this article as recorded by

Is Vaginal Prosthetic Surgery Always to Be Avoided? Analysis of the Efficacy and Safety of Vaginal Mesh With 3 Levels‐De Lancey Attachment in Women With Recurrent Vaginal Vault Prolapse
Lorenzo Campanella, Giovanni Grossi, Passarello Alessandra, Pietro Cignini, Fabio Manganelli, Pierluigi Palazzetti, M. A. Zullo, Andrea Morciano, Carlo Rappa, Francesco Deltetto, M. C. Schiavi
LUTS: Lower Urinary Tract Symptoms.2025;[Epub] CrossRef
Is HALP score a predictor of poor prognosis in patients with hematologic malignancies admitted to the intensive care unit?
Sevil Sadri, Burcu Tunay
The Egyptian Journal of Internal Medicine.2024;[Epub] CrossRef
Effects of mesh surgery on sexual function in pelvic prolapse and urinary incontinence
Gökmen Sukgen, Adem Altunkol, Ayşe Yiğit
International braz j urol.2021; 47(1): 82. CrossRef
Functional outcomes of synthetic tape and mesh revision surgeries: a monocentric experience
Salima Ismail, Emmanuel Chartier-Kastler, Christine Reus, Jérémy Cohen, Thomas Seisen, Véronique Phé
International Urogynecology Journal.2019; 30(5): 805. CrossRef
Comparison of advantages and disadvantages of 4- and 6-arm mesh prostheses in reconstructive surgery of the urogenital prolapse in women
О. V. Snurnitsina, M. V. Yenikeev, A. N. Nikitin, L. M. Rapoport, D. V. Enikeev, D. G. Tsarichenko, M. V. Lobanov, A. F. Abdusalamov
Andrology and Genital Surgery.2018; 19(4): 70. CrossRef

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