Sexual function and laparoscopic ventral rectopexy for complex rectocoele.
OBJECTIVE
Laparoscopic ventral rectopexy (LVR) has recently been shown to be feasible, safe and efficient in restoring anatomy and improving rectal emptying in female patients presenting with a posterior pelvic floor prolapse. However, little is known about the sexual function of these patients. This study aimed to assess sexual activity in a group of patients referred for complex rectocoele and the consequences on sexual comfort of their treatment after LVR.


METHODS
We prospectively assessed 41 consecutive patients who underwent LVR (either laparoscopic or robotic-assisted) for symptomatic complex rectocoele from January 2009 to January 2010. We first identified sexually active patients in the cohort using a nonvalidated simplified questionnaire. The Brief Index Sexual Functioning for Women (BISF-W) questionnaire was used postoperatively to assess the impact of LVR on sexual function. Acceptability of the assessment of sexuality was also tested. The postoperative outcome of the sexually active patients was compared with data obtained from the French general population.


RESULTS
Among 38 patients in whom a successful LVR had been performed (three conversions), 22 (57.9%) were sexually active preoperatively and 18 (47.4%) were sexually active postoperatively at a mean of 7±4.2months of follow-up (P=0.44). No de novo dyspareunia was reported. At baseline, 13 patients experienced dyspareunia compared with six after LVR (P=0.02). A significant improvement in dyspareunia was observed (seven patients vs two patients; P=0.03). 19 (86%) of the 22 patients responded to the BISF-W questionnaire. The mean composite score was 26.7±8.2, with 63.2% of patients estimating sexual activity as important or very important. Compared with a reference population, sexual comfort was similar in LVR patients (32.2±12.6 vs 26.7±8.2; P=0.14).


CONCLUSIONS
Assessment of sexual function is accepted by the majority of patients suffering from pelvic floor disorders. In addition to the benefit on anatomical restoration and bowel function, LVR improves sexual function and dyspareunia in patients operated on for complex rectocoele.
Clinique de Chirurgie Digestive et Endocrinienne, Institut des Maladies de l'Appareil Digestif, University Hospital of Nantes - Hôtel Dieu, Nantes, France.
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E
Abet
P A
PA
Lehur
M
M
Wong
J
J
Rigaud
E
E
Darnis
G
G
Meurette
D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000295:instrumentation / Q000379:methods*; D008875:Middle Aged; D011446:Prospective Studies; D020047:Rectocele / Q000150:complications / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D012371:Robotics; D012725:Sexual Behavior / Q000706:statistics & numerical data*; D012735:Sexual Dysfunction, Physiological / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D013526:Surgical Mesh; D011795:Surveys and Questionnaires; D016896:Treatment Outcome