Sylvie Van den Broeck1,2, Yves Jacquemyn3,4,5, Guy Hubens6,3, Heiko De Schepper7, Alexandra Vermandel8, Niels Komen6,3. 1. Department of Abdominal, Pediatric and Reconstructive Surgery, Antwerp University Hospital, Drie Eikenstraat 566, 2650, Edegem, Belgium. sylvie.vandenbroeck@uza.be. 2. Antwerp ReSURG, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, University of Antwerp, 2610, Antwerp, Belgium. sylvie.vandenbroeck@uza.be. 3. Antwerp ReSURG, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, University of Antwerp, 2610, Antwerp, Belgium. 4. Department of Obstetrics and Gynaecology, Antwerp University Hospital, 2650, Edegem, Belgium. 5. Global Health Institute (GHI), Faculty of Medicine and Health Sciences, University of Antwerp, 2610, Edegem, Antwerp, Belgium. 6. Department of Abdominal, Pediatric and Reconstructive Surgery, Antwerp University Hospital, Drie Eikenstraat 566, 2650, Edegem, Belgium. 7. Department of Gastroenterology and Hepatology, Antwerp University Hospital, 2650, Edegem, Belgium. 8. Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, 2610, Antwerp, Belgium.
Abstract
INTRODUCTION AND HYPOTHESIS: Women with a symptomatic rectocele may undergo different trajectories depending on the specialty consulted. This survey aims to evaluate potential differences between colorectal surgeons and gynecologists concerning the management of a rectocele. METHODS: A web-based survey was sent to abdominal surgeons (CS group) and gynecologists (G group) asking about their perceived definition, diagnostic workup, multidisciplinary discussion (MDT) and surgical treatment of rectoceles. The answers of both groups were analyzed with the chi-square test or Fisher's exact test at p < 0.050. RESULTS: A rectocele was defined as a prolapse of the posterior vaginal wall by 78% of the G and 41% of the CS group. All gynecologists and 49% of the CS group evaluated a rectocele clinically in dorsal decubitus, with 91% of gynecologists using a speculum and 65% using the Pelvic Organ Prolapse-Quantification (POP-Q) scoring system, compared to < 1/3 of colorectal surgeons. A digital rectal examination was performed by 90% of the CS group and 57% of the G group. A transvaginal ultrasound was only used by the G group, while anal manometry was opted for by the CS group (65%) and minimally by the G group (14%). In the G group, a posterior repair was the preferred surgical technique (78%), whereas 63% of the CS group preferred a rectopexy. Multidisciplinary discussions (MDT) were mostly organized ad hoc. CONCLUSIONS: An availability bias is seen in different aspects of rectocele evaluation and treatment. Colorectal surgeons and gynecologists are acting based on their training and experience. Motivation for pelvic floor MDT starts with creating awareness of the availability bias.
INTRODUCTION AND HYPOTHESIS: Women with a symptomatic rectocele may undergo different trajectories depending on the specialty consulted. This survey aims to evaluate potential differences between colorectal surgeons and gynecologists concerning the management of a rectocele. METHODS: A web-based survey was sent to abdominal surgeons (CS group) and gynecologists (G group) asking about their perceived definition, diagnostic workup, multidisciplinary discussion (MDT) and surgical treatment of rectoceles. The answers of both groups were analyzed with the chi-square test or Fisher's exact test at p < 0.050. RESULTS: A rectocele was defined as a prolapse of the posterior vaginal wall by 78% of the G and 41% of the CS group. All gynecologists and 49% of the CS group evaluated a rectocele clinically in dorsal decubitus, with 91% of gynecologists using a speculum and 65% using the Pelvic Organ Prolapse-Quantification (POP-Q) scoring system, compared to < 1/3 of colorectal surgeons. A digital rectal examination was performed by 90% of the CS group and 57% of the G group. A transvaginal ultrasound was only used by the G group, while anal manometry was opted for by the CS group (65%) and minimally by the G group (14%). In the G group, a posterior repair was the preferred surgical technique (78%), whereas 63% of the CS group preferred a rectopexy. Multidisciplinary discussions (MDT) were mostly organized ad hoc. CONCLUSIONS: An availability bias is seen in different aspects of rectocele evaluation and treatment. Colorectal surgeons and gynecologists are acting based on their training and experience. Motivation for pelvic floor MDT starts with creating awareness of the availability bias.
Authors: Philip Toozs-Hobson; Robert Freeman; Matthew Barber; Christopher Maher; Bernard Haylen; Stavros Athanasiou; Steven Swift; Kristene Whitmore; Gamal Ghoniem; Dirk de Ridder Journal: Int Urogynecol J Date: 2012-05 Impact factor: 2.894