title: Laparoscopic sacropexy and obstructed defecation syndrome: an anatomoclinical study.
abstract: OBJECTIVE
  Laparoscopic sacropexy (LSP) is associated with obstructed defecation syndrome (ODS) in 10-50% of cases. An anatomoclinical study was carried out to investigate whether there is any correlation between iatrogenic denervation during LSP and ODS.
  
  
  METHODS
  Five female cadavers were dissected to identify possible sites of nerve injury during LSP. Subsequently, the videos of 18 LSP were blindly reviewed to assess the location of sacral dissection and tacks, the position and depth of the peritoneal tunnel, and another 4 variables. An anatomical triangle was defined on the right lumbosacral spine so as to clearly describe the sites of the surgical variables, which were then statistically correlated with the patients' postoperative outcome.
  
  
  RESULTS
  The only variable associated with postsurgical ODS was dissection in the 90° angle of the anatomical triangle, where the superior hypogastric plexus was observed in all cadavers.
  
  
  CONCLUSIONS
  Medial and midline dissection over the sacral promontory might be associated with postoperative ODS.
authors.affiliation: Department of Gynecology and Obstetrics, Sant'Anna Hospital, University of Turin, Via Ventimiglia 3, 10126, Turin, Italy, cosmastefano@libero.it.
authors.forename: Stefano
authors.initials: S
authors.lastname: Cosma
authors.forename: Guido
authors.initials: G
authors.lastname: Menato
authors.forename: Marcello
authors.initials: M
authors.lastname: Ceccaroni
authors.forename: Gian Luigi
authors.initials: GL
authors.lastname: Marchino
authors.forename: Paolo
authors.initials: P
authors.lastname: Petruzzelli
authors.forename: Eugenio
authors.initials: E
authors.lastname: Volpi
authors.forename: Chiara
authors.initials: C
authors.lastname: Benedetto
mesh_terms: D002102:Cadaver; D003248:Constipation / Q000453:epidemiology* / Q000209:etiology*; D003672:Defecation; D003714:Denervation / Q000009:adverse effects; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects*; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology*; D015994:Incidence; D010535:Laparoscopy / Q000009:adverse effects*; D008160:Lumbosacral Plexus / Q000293:injuries; D008875:Middle Aged; D011184:Postoperative Period; D012189:Retrospective Studies; D013526:Surgical Mesh; D013577:Syndrome; D016896:Treatment Outcome; D014596:Uterine Prolapse / Q000601:surgery*
references.citation: Chirurg. 2004 Mar;75(3):276-83
references.pmid: 15021949
references.citation: Int Urogynecol J Pelvic Floor Dysfunct. 2003 Aug;14(3):164-8; discussion 168
references.pmid: 12955337
references.citation: J Physiol. 1974 Nov;243(1):153-66
references.pmid: 4155766
references.citation: J Am Coll Surg. 2005 Dec;201(6):913-7
references.pmid: 16310695
references.citation: J Physiol. 1981 Jan;310:457-69
references.pmid: 7230044
references.citation: Am J Obstet Gynecol. 1996 Jul;175(1):10-7
references.pmid: 8694033
references.citation: N Engl J Med. 2006 Apr 13;354(15):1557-66
references.pmid: 16611949
references.citation: BJOG. 2005 Aug;112(8):1134-8
references.pmid: 16045530
references.citation: Surg Radiol Anat. 2008 Aug;30(6):481-8
references.pmid: 18465081
references.citation: Am J Physiol. 1990 Jan;258(1 Pt 1):G59-64
references.pmid: 2301584
references.citation: Clin Orthop Relat Res. 1981 Jan-Feb;(154):114-8
references.pmid: 7471546
references.citation: Eur J Obstet Gynecol Reprod Biol. 2010 Sep;152(1):103-7
references.pmid: 20542624
references.citation: Obstet Gynecol. 2004 Oct;104(4):805-23
references.pmid: 15458906
references.citation: Dis Colon Rectum. 2003 May;46(5):621-8
references.pmid: 12792438
references.citation: Gastroenterology. 1983 Feb;84(2):409-17
references.pmid: 6336709
references.citation: Dis Colon Rectum. 1996 Jun;39(6):681-5
references.pmid: 8646957
references.citation: Best Pract Res Clin Obstet Gynaecol. 2005 Dec;19(6):941-58
references.pmid: 16198148
references.citation: Am J Obstet Gynecol. 2005 Jul;193(1):103-13
references.pmid: 16021067
references.citation: J Smooth Muscle Res. 2003 Apr;39(1-2):11-20
references.pmid: 12889852
references.citation: Int J Colorectal Dis. 1988 Jun;3(2):90-5
references.pmid: 3411187
references.citation: J Womens Health (Larchmt). 2005 Mar;14(2):128-36
references.pmid: 15775730
references.citation: Int Urogynecol J. 2011 Nov;22(11):1445-57
references.pmid: 21927941
references.citation: Eur Urol. 2009 May;55(5):1089-103
references.pmid: 19201521