M2R2: Multicenter Ventral Mesh Rectopexy Registry Collaborative

Sponsor

University Hospital, Antwerp (Other)

Overall Status

Not yet recruiting

CT.gov ID

NCT05918367

Collaborator

(none)

200

Enrollment

109

Anticipated Duration (Months)

Study Details

Study Description

Brief Summary

The goal of this multicenter observational study is to collect data prospectively of patients with pelvic organ prolapse undergoing ventral mesh rectopexy (as well as rectoceles, entero-/sigmoidoceles/ intussusception/ rectal prolapse or combined) by laparoscopy or robotic surgery and to evaluate the longterm functional outcomes.

Secondly complications (mesh erosions, recurrence, reoperations) are evaluated.

Following main questions will be analysed - other can follow in consultation with the collaborative

Is VMR the technique of choice for treatment of rectoceles? Functional results - recurrence - mesh related complications
Has a perineal descent an impact on the functional outcome of ventral mesh rectopexy perfored for external rectal prolaps, internal rectal prolaps, rectocele, enterocele, sigmoidcele or combined pelvic organ prolapse?

Condition or Disease	Intervention/Treatment	Phase
Pelvic Organ Prolapse Rectocele Enterocele Rectal Prolapse Descending Perineum Syndrome Surgery

Detailed Description

The study M2R2 is a multicentre registry based on the still ungoing monocentre study in the University Hospital of Antwerp.

Pelvic organ prolapse (POP) is a benign condition in which pelvic organs prolapse beyond their normal anatomical position due to weakening or damage to the pelvic floor muscles and other supporting tissues.[1] The incidence increases with age, multiparity, vaginal delivery and obesity.[2] POP can cause urinary, sexual and bowel complaints with a huge impact on quality of life.[3,4] Patients with posterior compartment prolapse may include symptoms of vaginal swelling, heaviness, perineal pressure and/or obstructive defecation with fragmented stools, need for hard straining, feeling of incomplete emptying, splinting, faecal urgency and even incontinence.[4] Ventral mesh rectopexy is surgical technique used to treat posterior compartment prolapse (rectocele, enterocele, sigmoidocele, rectal prolapse, combination) in patients with symptoms where conservative therapy fails or is ineffective. In this procedure, a mesh is placed between the back wall of the vagina and the rectum, the rectovaginal septum. This is attached at the level of the bone higher up (the promontorium) so that the back wall of the vagina is reinforced, preventing the prolapse to recurre.This technique was first described as technique to treat rectal prolapse by d'Hoore, a colorectal surgeon and widely accepted given the feasible transabdominal technique with good functional results. However, whether this technique gives also effective long-term anatomical and functional outcomes for rectoceles, enteroceles/sigmoidoceles +/- perineal descent, besides rectal prolapse, is not known.[5,6] Sometimes a combined procedure is necessary in which the anterior compartment (bladder) and/or middle compartment (cervix/vagina tip) is also reinforced.

The main objective of this registry is to collect data prospectively of patients with pelvic organ prolapse undergoing ventral mesh rectopexy (as well as rectoceles, entero-/sigmoidoceles/ intussusception/ rectal prolapse or combined) by laparoscopy or robotic surgery and to evaluate the longterm functional outcomes.

Secondly complications (mesh erosions, recurrence, reoperations) are evaluated.

The patients will be recruited from outpatient clinic of abdominal surgery in the participating centers. The treating physician recruits patients.

Methods and analysis

Data registry Parameters will be registered by means of case record form: History of the patient, urinary, prolapse, defecatory complaints, MRI or CR CCD if performed, anal manometry if performed, results of pelvic floor physiotherapy if performed. Surgical technique, operation time/length of stay and complications.
Questionnaire send to the patients at 5 time points

Preoperative - 3 months - 1 year - 3 years - 5 years postoperative

Questionnaires consisting of different topics I. In female: questions about childbirth (only preoperative) II. Medication III. Inventarisation of pelvic floor (dys)- function: PFDI-20 IV. Intestinal function and constipation

Wexner Vaizey-score
Low anterior resection syndrome score (LARS)
Bristol stool chart
Rome IV criteria functionam obstipation
Rome IV criteria IBS
CCS (Wexner constipation score)

Urinary (ICIQ-SF) VI. Seksuality (PISC-IR) VII. Impact of pelvic floor problem on quality of life (PISQ-7) VIII. Subjective satisfaction after surgery

Data management

Collected data will be entered in a case record form by the treating physician of the participating centre or by assigned study staff using the RedCap platform. Patients will be coded to insure patient anonymity.

Study Design

Study Type:

Observational [Patient Registry]

Anticipated Enrollment :

200 participants

Observational Model:

Cohort

Time Perspective:

Prospective

Official Title:

Multicenter Ventral Mesh Rectopexy Registry Collaborative

Anticipated Study Start Date :

Sep 1, 2023

Anticipated Primary Completion Date :

Sep 30, 2030

Anticipated Study Completion Date :

Sep 30, 2032

Outcome Measures

Primary Outcome Measures

Functional outcome [5 years]
Evaluation of the long-term functional outcomes of ventral mesh rectopexy (VMR) for posterior organ prolapse. Is VMR the surgical technique of choice for treatment of rectoceles?
Has perineal descent has an impact on the functional outcome of ventral mesh rectopexy performed for external rectal prolaps, internal rectal prolaps, rectocele, enterocele, sigmoidocele or combined pelvic organ prolapse? [5 years]

Secondary Outcome Measures

recurrence of posterior pelvic organ prolapse - new onset of symptoms [5 years]
mesh related complications [5 years]

Eligibility Criteria

Criteria

Ages Eligible for Study:

18 Years and Older

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

Inclusion Criteria:

Diagnosis of posterior pelvic organ prolaps planned for laparoscopie or robotic ventral mesh rectopexy with or without concomittant surgery.
All patients 18 years or older and are able to complete a written informed conscent are eligble for inclusion.

Exclusion Criteria:

Inability to complete a written informed conscent
Pregnant women
No email adress available to send the questionnaires to
Language barrier or impossiblity to fill in the questionnaires (at the discretion oft he treating physician)