Prospective Randomized Controlled Trial of Obstructed Defecation Surgery

Not Applicable

Recruiting

• Conditions: Obstructed Defecation; Pelvic Organ Prolapse
• Interventions: Procedure: Laparoscopic abdominal ventral rectopexy; Procedure: Transvaginal sacrospinous rectopexy

• Registration Number: NCT05747027
• Lead Sponsor: Endeavor Health

Brief Summary

Obstructive defecatory syndrome (ODS) or inability to completely empty bowel is characterized by a combination of straining, incomplete evacuation, and the use of digital manipulation with bowel movement. This is a common condition with estimated incidence of 15-20% in the adult female population.

Laparoscopic abdominal ventral rectopexy is an established surgical technique aimed at restoring rectal support in women with this condition. It is the most common surgery used nowadays to treat ODS. Transvaginal sacrospinous rectopexy, is an innovative procedure which has been shown to be safe and effective in the treatment of stool entrapment. Currently it is unknown whether one of the procedures mentioned is superior to the other regarding surgical outcomes and patient experience. The purpose of this research is to compare the outcomes of these two procedures considering their efficacy to improve symptoms.

During the study, participants will be randomized to undergo one of two procedures for treatment of inability to completely empty their bowel and/or rectal prolapse: 1) laparoscopic abdominal ventral rectopexy; 2) transvaginal sacrospinous rectopexy. Following the procedure, participants will be asked to return to the office for a follow-up visit 2-weeks, 2-, 12- and 24-months after the surgery. During each follow-up visit participants will undergo symptom evaluation, pelvic exam and transvaginal pelvic ultrasound to evaluate surgical success.

Detailed Description

Not available

Study Timeline

• Study First Submitted: 2023-02-05
• Study First Submitted QC: 2023-02-16
• Study First Posted: 2023-02-28
• Study Start: 2024-05-16
• Status Verified: 2025-03
• Last Update Submitted: 2025-03-21
• Last Update Posted: 2025-03-25
• Primary Completion: 2028-02
• Study Completion: 2028-02

Recruitment & Eligibility

• Status: RECRUITING
• Sex: Female
• Target Recruitment: 120

Inclusion Criteria

1. Female, between the age of 18 and 80

2. OD symptoms as indicated by an affirmative response to either questions 7, 8 or 14 of the Pelvic Floor Distress Inventory (PFDI):

   1. Do you feel you need to strain too hard to have a bowel movement?
   2. Do you feel you have not completely emptied your bowels at the end of a bowel movement?
   3. Does part of your bowel ever pass through the rectum and bulge outside during or after a bowel movement?

3. Rectal hypermobility defined as a compression ratio greater than 50% according to ultrasound

4. Patient planning on undergoing surgery for the repair of pelvic organ prolapse within the next 12 months

5. Patient who is not pregnant and does not intend to become pregnant in the next 2 years

6. Available for 24-months of follow-up

7. Stated willingness to comply with all study procedures and availability for the duration of the study

8. Able to complete study assessments, per clinician judgment

9. Able and willing to provide independent written informed consent

10. Stable cardiovascular and respiratory status to meet candidacy in vaginal or laparoscopic surgeries

Exclusion Criteria

1. Contraindication to abdominal and transvaginal rectopexy in the opinion of the treating surgeon
2. History of previous surgery that included any type of surgery for rectal prolapse
3. Pelvic pain or dyspareunia due to levator ani spasm that would preclude a PMT program
4. Previous adverse reaction to synthetic mesh
5. Current cytotoxic chemotherapy or current or history of pelvic radiation therapy within 12 months
6. History of two inpatient hospitalizations for medical comorbidities in the previous 12 months

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
laparoscopic abdominal ventral rectopexy	Laparoscopic abdominal ventral rectopexy	-
transvaginal sacrospinous rectopexy	Transvaginal sacrospinous rectopexy	-

Primary Outcome Measures

Name	Time	Method
Degree of rectal hypermobility measured via ultrasound	24 months post-operatively	The degree of rectal hypermobility measured via ultrasound (i.e. compression ratio).

Secondary Outcome Measures

Name	Time	Method
Postoperative pain measured by pain scale	24 months post-operatively	Participants will complete the pain scale. No pain will indicate the best outcome whereas the most intense pain imaginable will indicate the worst outcome.
Postoperative pain measured by pain medication use	24 months post-operatively	Participants will complete an assessment of pain medication use.
Postoperative functional activity level	24 months post-operatively	Participants will complete the Activity Assessment Scale which measures functional activity. The activity level will be measured on a scale of no difficulty, a little difficulty, some difficulty, a lot of difficulty, not able to do it, and did not do it for other reasons.
Global improvement in bladder function	24 months post-operatively	Participants will complete the Patient Global Impression of Improvement. The improvement will be measured on a scale of very much better, much better, a little better, no change, a little worse, much worse, and very much worse.
Pelvic Floor Distress Inventory (PFDI) - POPDI	24 months post-operatively	As a part of the pelvic floor distress inventory (PFDI) questionnaire, participants will complete prolapse symptoms assessments using pelvic organ prolapse distress inventory (POPDI). The symptoms will be measured on a scale of 0, present, to 4, quite a bit. A higher score will indicate a higher symptom burden.
Pelvic Floor Distress Inventory (PFDI) - CRADI	24 months post-operatively	As a part of the pelvic floor distress inventory (PFDI) questionnaire, participants will complete colorectal symptoms assessments using colorectal anal distress inventory (CRADI). The symptoms will be measured on a scale of 0, present, to 4, quite a bit. A higher score will indicate a higher symptom burden.
Pelvic Floor Distress Inventory (PFDI) - UDI	24 months post-operatively	As a part of the pelvic floor distress inventory (PFDI) questionnaire, participants will complete urinary symptoms assessments using urinary distress inventory (UDI). The symptoms will be measured on a scale of 0, present, to 4, quite a bit. A higher score will indicate a higher symptom burden.
Quality of life measured by PFIQ	24 months post-operatively	Participants will complete pelvic floor impact questionnaire (PFIQ), a condition-specific health-related quality of life questionnaire. The measurement will be on a scale of 0, not at all, to 3, quite a bit. Higher scores indicate greater impact.
Quality of life measured by SF-36	24 months post-operatively	Participants will also complete short form health survey (SF-36), which measures eight scales: physical functioning (PF), role physical (RP), bodily pain (BP), general health (GH), vitality (VT), social functioning (SF), role emotional (RE), and mental health (MH). Higher scores indicate better health status.
Quality of life measured by EQ-5D	24 months post-operatively	Participants will complete EuroQol-5D (EQ-5D), an instrument that evaluates quality of life on five dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. The measurement will be on a scale of 1 to 5.
Pelvic muscle strength	24 months post-operatively	Participants will complete the Brink Scale, a digital assessment of pelvic floor muscle strength. It consists of 3 separate 4-point rating scales for pressure, vertical finger displacement, and duration.

Trial Locations

Locations (2)

Endeavor Health; 🇺🇸 Skokie, Illinois, United States

Weill Cornell Medicine; 🇺🇸 New York, New York, United States