Society for Surgery of the Alimentary Tract
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The Effect of Surgically Induced Weight Loss on Pelvic Floor Disorders in Morbidly Obese Women
Nir Wasserberg, Patrizio Petrone, Mark Haney, salman Khan, Peter F. Crookes, Maria Harrison, Howard S. kaufman; surgery, University of Southern California, Los Angeles, CA

Purpose: Urinary incontinence is a common symptom in morbidly obese women. The prevalence of other pelvic floor disorders (PFD’s) is less well documented. While many metabolic comorbidities resolve following bariatric surgery, resolution of global pelvic floor dysfunction has not been well described. The purpose of this study is to evaluate the effect of surgically induced weight loss on pelvic floor disorders (PFD) in morbidly obese women. Methods: 400 women investigating surgical weight loss completed 2 validated questionnaires of pelvic floor dysfunction (Pelvic Floor Distress Inventory - PFDI-20 and Pelvic Floor Quality of Life Impact Questionnaire - PFIQ-7). Both instruments are sensitive tools designed to detect initial prevalence as well as post treatment outcomes by evaluating 3 main domains of PFD: pelvic organ prolapse distress /impact, colorectal -anal distress/impact, and urogenital distress/urinary incontinence impact. To date, 30 women who have achieved ≥50% excess body weight (EBW) loss have completed postoperative questionnaires. Pre- and postoperative scores were compared by Wilcoxon signed rank tests. Results: Of these 30 patients, 25 (83%), median age 39 (23-67), mean BMI: 44.4 ±3.6 kg/m2, reported various degrees of preoperative PFD’s with corresponding negative impact on QOL (r=0.3, P=0.02). At a median follow-up of 17 months (10-21), mean %EBW loss was 77±36%, and mean BMI was 25.2±2.4 kg/m2 (P<0.001 vs preop). A statistically significant decrease was demonstrated in total mean post surgery distress scores (47±7.8 to 21.4±6.3, P=0.04), mainly contributed by a decrease in urinary symptoms (20.2±4.2 to 4.4±1.6, P<0.01). Other PFD domains showed a reduction in symptom scores without achieving statistical significance. There was a trend towards improvement in QOL scores (P=0.08). Conclusion: Surgically induced weight loss significantly reduces symptoms of pelvic floor disorders in morbidly obese women.


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