eP314 - Rectal Prolapse Repair Improves Bowel Symptoms in Women with Psychiatric Diseases

Purpose/Background: Psychological factors play an important role in functional bowel disorders and is commonly described as the “gut-brain connection.” For patients with rectal prolapse, the impact of co-morbid psychiatric disease on symptoms is unknown and may affect postoperative functional outcomes. We evaluated the association between psychiatric disease and symptom improvement for patients undergoing rectal prolapse repair.Methods/Interventions: Retrospective cohort analysis of an IRB-approved registry of patients undergoing rectal prolapse repair from 2017-present. Patients were included if they had surgery for rectal prolapse, had data on psychiatric comorbidities, and had preoperative Pelvic Floor Distress Inventory (PFDI-20) scores. Pre- and postoperative obstructed defecation scores (ODS) and Cleveland Clinic Fecal Incontinence Scores (CCFIS) were also collected. We compared scores for patients with and without psychiatric disease and used a linear mixed-effects model for the 1-year change in PFDI scores adjusted for age, postoperative complications, and recurrence, stratified by surgery type (rectopexy alone versus rectopexy with concurrent pelvic organ prolapse repair).Results/Outcomes: Of 344 female patients in our registry, 137 met inclusion criteria. 50 (36%) had a psychiatric disease (PD) and 87 (64%) did not. Depression and anxiety were the most prevalent conditions. Patients with PD tended to be younger (median [IQR] age: 61 [48, 67] vs. 70 [60,77], p < 0.001), reported a history of constipation (52% vs. 33%, p=0.03), and had rectal prolapse symptoms for over 1 year (76% vs 59% p=0.04) (Table 1). Preoperative PFDI scores were higher in patients with PD (median [IQR]: 145 [79, 201] vs. 109 [75, 158]) primarily due to worse CRADI bowel sub-scores (median [IQR]: 70 [47, 84] vs. 53 [38, 69]). Baseline ODS scores (9 [4, 12] vs. 8 [4, 11]) and CCFIS scores (14 [9, 17] vs. 15 [11, 17]) were similar.Across the cohort, most patients had ventral mesh rectopexy (64%), and nearly half had a combined vaginal prolapse repair (47%). Type of surgery did not differ between groups. Rate of 30-day complications (Clavien Dindo Grade >=2: 14% vs. 8% p=0.32), readmission within 30 days (4% vs. 5%, p>0.99), and 1-year recurrence (6% vs. 8%, p=0.75) were similar between the groups . At 1-year postoperative among rectopexy patients, PFDI scores improved in both groups (adjusted mean change from baseline [95% CI]: -100 [-148, -52] vs. -46 [-76, -16]) but significantly more so in the group with PD (p=0.05). CCFIS scores improved significantly in both groups among rectopexy patients, but there was not differential improvement between groups; ODS scores improved significantly for rectopexy patients without PD (-2.6 [-4.8, -0.4]) but we did not see significant improvement for patients with PD (-3.2 [-6.9, 0.6]).Conclusion/

Discussion: Patients with PD present with rectal prolapse later and report a higher degree of bothersome symptoms at baseline based on validated scores. Fortunately, these patients also experience significant improvement after repair suggesting that appropriate management of their prolapse can improve their quality of life. Prevention and long-term durability of symptom improvement should be the focus of further work.Table 1. Patient characteristics