Role of Levatorplasty in Management of Rectal Prolapse in Patients with Wide Pelvic Hiatus

Role of Levatorplasty in Management of Rectal Prolapse in Patients with Wide Pelvic Hiatus | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Role of Levatorplasty in Management of Rectal Prolapse in Patients with Wide Pelvic Hiatus Ali Ahmed Shafik, Mohamed Yehia El-barmelgi, Osama Refaei Mohamed, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3342754/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose Rectal prolapse (RP) is a debilitating condition associated with symptoms such as fecal incontinence, obstructed defecation, incomplete rectal evacuation, and significant discomfort. Recent evidence highlights the strong correlation between prolapse development and the size of the pelvic hiatus (GH). Surgical studies have suggested a potential link between an enlarged pelvic hiatus and prolapse recurrence. This study aims to evaluate recurrence rates in patients with rectal prolapse characterized by a wide pelvic hiatus who underwent surgical management. Methods In this prospective cohort study, 60 patients with rectal prolapse and a wide pelvic hiatus were divided into two groups, each comprising 30 patients. One group underwent rectal prolapse repair, while the other group underwent rectal prolapse repair with levatorplasty. Results The levatorplasty group exhibited notable improvements in Wexner scores and lower recurrence rates compared to the other group. Both groups demonstrated similar outcomes in terms of postoperative pain and dyspareunia. Conclusion Rectal prolapse repair combined with levatorplasty represents an effective approach for patients presenting with rectal prolapse and a wide pelvic hiatus. This combination results in improved Wexner scores and reduced recurrence rates, providing valuable insights into the management of this challenging condition. Surgery General Surgery Levatorplasty Rectal prolapse Wide pelvic hiatus MRI defecography coloproctology colorectal surgery Figures Figure 1 Figure 2 Figure 3 Introduction Rectal prolapse and internal intussusception encompass a spectrum of anatomical abnormalities involving the descent of rectal wall tissue, often accompanied by pelvic floor dysfunction ( 1 ). Despite their benign nature, these disorders can severely debilitate patients due to the associated pain, discharge of blood or mucus, and a high incidence of fecal incontinence or constipation. Common findings in rectal prolapse patients include diastasis of the levator ani, an excessively deep cul-de-sac, a redundant sigmoid colon, a patulous anal sphincter, and loss of rectal sacral attachments. While rectal prolapse treatment traditionally focused on restoring normal anatomy, achieving consistent success has proven challenging, necessitating various procedures ( 2 ). This condition predominantly affects women over the age of 70 and is often associated with pelvic floor issues such as vaginal prolapse, enterocele, cystocele, rectocele, and urinary incontinence. Multi-parity and weak pelvic floor musculature are frequently implicated in the development of these disorders, with rectal prolapse being six times more common in women than in men ( 3 ). Surgery remains the primary treatment modality for rectal prolapse. However, an increasing number of surgical techniques have been reported in the literature, with both abdominal and perineal approaches considered. The choice of surgical strategy depends on factors such as the patient's comorbidities, age, bowel function, and the surgeon's experience ( 4 ). A critical component of the pelvic floor diaphragm is the puborectalis (PR) muscle, one of the three muscular slings of the levator ani (LA) muscle complex. Innervated by the pudendal nerve, the PR muscle plays a pivotal role in pelvic floor function ( 5 ). Pregnancy and childbirth can place significant stress on the PR muscle, potentially causing tears and damage to this complex structure. This trauma can harm connective tissue and the rectovaginal septum, disrupting LA innervation and leading to discomfort, either immediately following delivery or years later ( 5 ). Peri-partum perineal trauma can also damage anal sphincters, the perineal body, and contribute to the development of rectoceles ( 7 ). The levator hiatus expands following delivery, starting from 13.8 ± 1.7 cm² in nulliparous women to 24.2 ± 2.1 cm² after childbirth, often due to either complete or incomplete LA muscle injuries ( 8 ). Given the challenges in distinguishing muscle boundaries through imaging techniques, this study refers to the muscle surrounding the levator hiatus as the LA muscle ( 9 ). By exploring the role of Levatorplasty in the surgical management of rectal prolapse, this study aims to contribute to our understanding of effective treatment strategies for this debilitating condition. Patients and Method This prospective case-control study was conducted at Kasr-Al-Aini Hospital in Cairo, Egypt, spanning from July 2021 to February 2023. It comprised a cohort of 60 patients, evenly divided into 30 cases and 30 controls. The ethical considerations were diligently addressed, with all participating patients providing written consent after comprehensive counseling regarding both the Levatorplasty procedure and their participation in the study. Ethical approval for the study was obtained from the Kasr-Al-Aini Research Ethical Committee. The gender distribution among all studied patients was as follows: 6.7% male and 93.3% female, reflecting the predominance of this condition in the female population. Inclusion criteria for the study encompassed patients who met the following criteria: 1. Age of 18 years or older. 2. Symptomatic rectal prolapse with a wide pelvic hiatus. 3. Patients who had not responded to conservative management. 4. Patients deemed fit for anesthesia and surgery. Exclusion criteria were defined to exclude specific groups or conditions that might confound the study results. Excluded were patients with: 1. Recurrent rectal prolapse. 2. Previous rectal surgery. 3. Neuromuscular deficiencies. 4. Previous Levator ani tears (due to trauma or surgery). 5. Vulnerable groups such as pregnant individuals, children, those incarcerated, or those unable to provide informed consent. The primary outcome under investigation was the recurrence of rectal prolapse following surgical repair in patients presenting with rectal prolapse and a wide levator hiatus. The secondary outcomes comprised: 1. Assessment of post-operative pain. 2. Evaluation of the persistence, re-occurrence, or newly developed dyspareunia. 3. Examination of the differences in operative time between both groups. 4. Analysis of variations in post-operative hospital stay between the two groups. All patients underwent rectal prolapse surgery, including ALTEMEIER, STARR, Ventral Mesh Rectopexy, or pelvic organ prolapse surgery (POPS), as a primary one-stage procedure. Importantly, the same surgical technique was consistently applied across the study cohort. Patients were divided into two groups, with one group undergoing rectal prolapse surgery with Levatorplasty and the other without Levatorplasty. The preoperative evaluation encompassed an extensive assessment protocol, including a thorough medical history, complete laboratory workup, psychological counseling, dietetic counseling, and the assessment of the Wexner score (11). Various patient characteristics, including age, weight, BMI, disease duration, current treatment, presence of constipation or incontinence, medical history, previous surgery history, and dyspareunia, were documented before surgery. Postoperatively, patients were diligently followed up at 12 and 24 months. During these follow-up visits, various data points were collected, including the presence of constipation or incontinence, Wexner score, dyspareunia, postoperative pain, recurrence, operative time, and hospital stay. The comprehensive pre-operative workup included: 1. A thorough clinical assessment, including medical history, BMI assessment, evaluation of diabetes mellitus (including disease duration and treatment), presence of constipation or incontinence, Wexner score, and dyspareunia assessment. 2. Laboratory investigations encompassing liver and kidney function tests, coagulation profile, and a full blood count. 3. Chest X-ray. 4. Abdominal and pelvic ultrasound. 5. MRI Defecography, enabling a detailed assessment of rectal prolapse and the Levator hiatus. 6. Laboratory tests to assess glucose homeostasis, including Glycated Hb. The surgical procedures in our study were conducted under general anesthesia with patients positioned in the lithotomy position. The surgeon was positioned between the patient's legs to facilitate access and precision during the operation. To ensure patient stability and accessibility, secure fixation to the operating table was employed, allowing for placement in the anti-Trendelenburg position. The standard rectal prolapse surgeries performed in our study included ALTEMEIER’S, STARR, Ventral Mesh Rectopexy, and POPS procedures. These well-established surgical techniques were chosen to address rectal prolapse and its associated symptoms effectively. For patients who underwent rectal prolapse surgery with levatorplasty, a specific approach was employed. A U-curved incision was made posterior to the anal verge, and dissection was carried out until the levator ani muscle was reached. The critical step involved approximating both limbs of the puborectalis muscle using polydioxanone sutures (PDS) 3-0. This technique aimed to strengthen the pelvic floor and enhance anatomical support. It is important to note that all levatorplasty procedures were performed by the same experienced operator, ensuring consistency and uniformity in the surgical approach across the study. By adhering to these standardized surgical protocols and techniques, we aimed to optimize the outcomes and minimize variability, ultimately contributing to the validity and reliability of our study results. In the post-operative phase of our study, a comprehensive assessment was conducted to evaluate various key aspects of patient outcomes. This assessment included the following parameters: 1. Early and Late Postoperative Complications: We meticulously examined and documented both early and late complications that arose in our patients following the surgical procedures. This analysis allowed us to assess the safety and potential risks associated with each intervention. 2. Effect of the Procedure on Wexner Score: The impact of the surgical procedure on the Wexner score, a critical indicator of bowel function and continence, was thoroughly evaluated. This assessment provided valuable insights into the functional improvements achieved through each surgical approach. 3. Effect of the Procedure on Recurrence: In cases where recurrence occurred, further investigation was conducted using MRI defecography to gain a deeper understanding of the anatomical changes and potential causes. This information was instrumental in refining our surgical techniques and preventing future recurrences. 4. Effect of the Procedure on Postoperative Pain (VAS): The level of postoperative pain experienced by patients was quantified using the Visual Analogue Scale (VAS). This assessment allowed us to compare and contrast pain levels between different surgical groups and approaches, contributing to our understanding of patient comfort and recovery. 5. Presence of Dyspareunia: The presence or absence of dyspareunia, a condition characterized by pain during sexual intercourse, was carefully documented. This assessment helped us gauge the impact of the surgical interventions on patients' sexual health and well-being. 6. Postoperative Hospital Stay: The duration of postoperative hospitalization for each patient was recorded. This information provided insights into the immediate recovery period and potential variations in hospital stay among different surgical approaches. Statistical analysis of the data was conducted using SPSS (Statistical Program for Social Science) version 21. This analysis encompassed a range of statistical methods and techniques: Quantitative variables were summarized using statistical descriptors such as mean, median, standard deviation (SD), and interquartile range. These summaries offered a clear overview of the central tendencies and dispersion within the data. Qualitative variables were presented as counts and percentages, providing a concise representation of categorical data. To assess changes over time and differences between groups, we utilized statistical tests, including repeated measure ANOVA for parametric data (SD 30% of the mean). We also employed Related-Samples Friedman's Two-Way Analysis of Variance by Ranks test for non-parametric data when appropriate. Overall, this rigorous statistical analysis allowed us to draw meaningful conclusions from our data, leading to a deeper understanding of the outcomes and implications of the surgical procedures under investigation. Results All patients underwent either Ventral Mesh Rectopexy, STARR, Altemeier's procedure, or POPS procedure as a primary one-stage surgical intervention, using the same surgical technique, with or without levatorplasty. This occurred over a 20-month period at EL Kasr Alaini Teaching Hospital from July 2021 to February 2022. Patients presenting with rectal prolapse and eligible for surgery were divided into two groups: one group underwent Rectal Prolapse surgery with levatorplasty (30 patients), while the other underwent Rectal Prolapse surgery without levatorplasty (30 patients). No. = 60 Sex Female 56 (93.3%) Male 4 (6.7%) Range 33–48 Table (1): Gender distribution of all study subjects With Levatorplasty Without Levatorplasty No. = 30 No. = 30 Sex Female 28 (93.3%) 28 (93.3%) Male 2 (6.7%) 2 (6.7%) Table (2): Gender distribution in both groups Age Distribution: The mean age of all studied patients was 47.30 ± 5.30 years, with an age range of 30 to 58 years. In the Levatorplasty group, the mean age was 47.47 ± 4.59 years, while in the Without Levatorplasty group, it was 47.13 ± 6.00 years. There was no statistically significant difference in pre-operative age between the two groups. With Levatorplasty Without Levatorplasty Test value P-value Sig. No. = 30 No. = 30 Age Mean ± SD 47.47 ± 4.59 47.13 ± 6.00 0.242• 0.810 NS Range 33–55 30–58 Table (3): Age distribution in both groups BMI (Body Mass Index): The mean weight of all studied patients was 37.20 ± 2.94 with a weight range of 33 to 48 kg. In the Levatorplasty group, the mean weight was 36.73 ± 2.26, while in the Without Levatorplasty group, it was 37.67 ± 3.47. There was no statistically significant difference in pre-operative weight between the two groups. With Levatorplasty Without Levatorplasty Test value P-value Sig. No. = 30 No. = 30 BMI Mean ± SD 36.73 ± 2.26 37.67 ± 3.47 -1.235• 0.222 NS Range 33–46 33–48 Table (4): Weight distribution in both groups Risk Factors: Out of the total patients, 54 (90%) were multiparous, while 2 patients (3.3%) were nulliparous, and 4 patients (6.7%) were male. In the Levatorplasty group, 27 patients (90%) were multiparous, which was consistent with the other group. There were no statistically significant differences between the two groups regarding pre-operative risk factors. Figure ( 2 ) Risk Factor distribution in both groups (RF were distributed equally) With Levatorplasty Without Levatorplasty Test value P-value Sig. No. = 30 No. = 30 Risk factor No 2 (6.7%) 2 (6.7%) 0.000* 1.000 NS Nulipara 1 (3.3%) 1 (3.3%) Multipara 27 (90.0%) 27 (90.0%) Table (5): Risk Factors in both groups Change in Wexner Score for Incontinence Over Time: In all the patients included in our study, there was a notable decrease in the Wexner score over time, specifically comparing pre-operative and post-operative assessments. This decrease was statistically significant, with a p-value of less than 0.001. No. = 60 Wexner Pre Median (IQR) 15 (11–17) Range 3–22 Wexner Post Median (IQR) 0 (0–3) Range 0–19 Willcoxon Rank test -6.459 P-value < 0.001 (HS) Table (6): Wexner score changes over time in all studied patients In the Levatorplasty group, a significant decrease in the median Wexner score was observed over time, with a pre-operative median of 15 and a post-operative median of 0. This reduction was statistically significant, with a p-value of less than 0.001. Similarly, in the Without Levatorplasty group, there was a significant decrease in the median Wexner score over time, with a pre-operative median of 15 and a post-operative median of 1. This reduction was also statistically significant, with a p-value of less than 0.001. Comparing the postoperative median Wexner scores between the Without Levatorplasty group (median of 1) and the Levatorplasty group (median of 0), it's evident that the reduction in the Wexner score was more pronounced in the Levatorplasty group. However, this difference did not reach statistical significance (p-value = 0.07). With Levatorplasty Without Levatorplasty Test value‡ P-value Sig. No. = 30 No. = 30 Wexner Pre Median (IQR) 15 (12–17) 15 (10–17) -0.037 0.970 NS Range 8–20 3–22 Wexner Post Median (IQR) 0 (0–1) 1 (0–7) -1.779 0.075 NS Range 0–16 0–19 Willcoxon Rank test -4.710 -4.464 P-value < 0.001 (HS) < 0.001 (HS) Table (7): Comparison between With Levatorplasty and Without Levatorplasty regarding Wexner score pre-operative and post-operative in all patients Recurrence was observed in 7 out of all studied patients, constituting 11.7% of the total, while a significant majority of 53 patients (88.3%) did not experience recurrence. In the Levatorplasty group, the rate of postoperative recurrence was notably low, with only 1 case (3.3%) showing recurrence. This was in contrast to the Without Levatorplasty group, where 6 patients (20%) experienced recurrence. The difference in recurrence rates between these two groups was statistically significant, with a p-value of 0.044. The table clearly illustrates that there was a significant statistical difference between the With Levatorplasty group and the Without Levatorplasty group in terms of recurrence, emphasizing the positive impact of levatorplasty on reducing recurrence rates. With Levatorplasty Without Levatorplasty Test value P-value Sig. No. = 30 No. = 30 Recurrence No 29 (96.7%) 24 (80.0%) 4.043* 0.044 S Yes 1 (3.3%) 6 (20.0%) Table (8): Comparison between Levatorplasty group and Without Levatorplasty group regarding post-operative Recurrence in both groups Post-operative Pain: After the surgical procedures, post-operative pain was assessed in all the studied patients, with a mean pain score of 4.30 ± 1.18 and a range between 2 and 7 on the pain scale. The assessment of pain was conducted using the Visual Analog Scale (VAS) score, where a score of 0 indicated no pain, scores from 1 to 3 represented mild pain, scores from 4 to 6 indicated moderate pain, scores from 7 to 9 signified severe pain, and a score of 10 represented the worst pain. The mean postoperative pain score in the Levatorplasty group was 4.37 ± 1.27, while in the Without Levatorplasty group, it was 4.23 ± 1.10. Importantly, there was no statistically significant difference observed between the two groups in terms of postoperative pain, with a p-value of 0.433. These findings suggest that the presence or absence of levatorplasty did not result in a statistically significant difference in post-operative pain levels among the patients in the study. With Levatorplasty Without Levatorplasty Test value P-value Sig. No. = 30 No. = 30 Post-operative pain Mean ± SD 4.37 ± 1.27 4.23 ± 1.10 0.433• 0.666 NS Range 2–7 2–7 Table (9): Comparison between With Levatorplasty and Without Levatorplasty regarding post-operative pain in all patients Dyspareunia Findings: Dyspareunia, a condition characterized by pain during sexual intercourse, was reported in 9 out of all the patients, comprising 15% of the total, while a significant majority of 51 patients (85%) did not experience dyspareunia. Examining the data further, Table 10 illustrates that dyspareunia occurred in 5 patients (16.7%) within the Levatorplasty group. In comparison, dyspareunia was reported in 4 patients (13.3%) in the Without Levatorplasty group. However, it's important to note that this difference in the occurrence of dyspareunia between the two groups was not found to be statistically significant, with a p-value of 0.131. This suggests that the presence or absence of levatorplasty did not result in a statistically significant difference in the occurrence of dyspareunia among the patients in the study. With Levatorplasty Without Levatorplasty Test value P-value No. = 30 No. = 30 Dysparunia No 25 (83.3%) 26 (86.7%) 0.131* 0.718 Yes 5 (16.7%) 4 (13.3%) Table (10): Comparison between both groups regarding Dyspareunia Operative Time: The mean operative time for both groups combined was 44.05 ± 13.75 minutes, with a range spanning from 18 to 90 minutes. Looking at the data in more detail, the table indicates that the mean operative time in the Levatorplasty group was 47.33 ± 13.00 minutes. In contrast, the mean operative time in the Without Levatorplasty group was 40.77 ± 13.90 minutes. However, it's important to note that the difference in mean operative time between these two groups did not reach statistical significance, with a p-value of 0.064. This suggests that there was no statistically significant difference in the mean operative times between the group that underwent levatorplasty and the group that did not. With Levatorplasty Without Levatorplasty Test value P-value Sig. No. = 30 No. = 30 Operative time Mean ± SD 47.33 ± 13.00 40.77 ± 13.90 1.890• 0.064 NS Range 30–90 18–60 Table (11): Comparison between With Levatorplasty and Without Levatorplasty regarding post-operative data in all patients No. % With Levatorplasty ALTEMEIER’S operation 5 16.7% POPS operation 5 16.7% Rectopexy operation 10 33.3% STARR operation 10 33.3% Without Levatorplasty ALTEMEIER’S operation 5 16.7% POPS operation 5 16.7% Rectopexy operation 10 33.3% STARR operation 10 33.3% Table (12): Operative data in both groups ALTEMEIER'S Operation: Five patients from each group underwent the ALTEMEIER'S procedure. Here are the findings: (A) The mean postoperative pain in both groups was similar, with a value of 4.2 ± 0.84. There was no statistically significant difference in postoperative pain between the two groups (P value 1). (B) In terms of dyspareunia, 5 patients in the Levatorplasty group and 4 patients in the Without Levatorplasty group reported no dyspareunia. However, the difference in dyspareunia occurrence between these two groups was not statistically significant (P value 0.292). (C) For the occurrence of recurrence, 5 patients in the Levatorplasty group and 4 patients in the Without Levatorplasty group showed no recurrence. Similarly, there was no statistically significant difference in recurrence rates between these two groups (P value 0.292). (D) In both groups, all patients had a one-day post-operative hospital stay. (E) When it comes to operative time, there was a significant difference between the groups. The mean operative time in the Levatorplasty group was 36.00 ± 4.18 minutes, whereas in the Without Levatorplasty group, it was 24.40 ± 4.04 minutes. This difference in operative time between the two groups was statistically significant, with a p-value of 0.002. These findings provide insights into the outcomes and characteristics associated with the ALTEMEIER'S procedure in both groups, emphasizing the significance of operative time as a differentiating factor. ALTEMEIER’S operation With Levatorplasty Without Levatorplasty Test value P-value Sig. No. = 5 No. = 5 Post-operative pain Mean ± SD 4.2 ± 0.84 4.2 ± 0.84 0.000• 1.000 NS Range 3 – 5 3 – 5 Dyspareunia No 5 (100.0%) 4 (80.0%) 1.111* 0.292 NS Yes 0 (0.0%) 1 (20.0%) Recurrence No 5 (100.0%) 4 (80.0%) 1.111* 0.292 NS Yes 0 (0.0%) 1 (20.0%) Hospital Stay 1 Day 5 (100.0%) 5 (100.0%) NA NA NA Operative time Mean ± SD 36.00 ± 4.18 24.40 ± 4.04 4.462• 0.002 HS Range 30 – 40 20 – 30 Table (13): Comparison between With Levatorplasty and Without Levatorplasty regarding postoperative data in ALTEMEIER’S operation Table shows Postoperative, median Wexner score in Without Levatorplasty (1) was less that in Levatorplasty group (0) so Wexner score reduction in Levatorplasty group is more than in Without Levatorplasty but with no statistically significant difference (P value 0.4). ALTEMEIER’S operation With Levatorplasty Without Levatorplasty Test value‡ P-value Sig. No. = 5 No. = 5 Wexner Pre Median (IQR) 12 (10 - 12) 12 (10 - 12) -0.108 0.914 NS Range 8 – 13 8 – 15 Wexner Post Median (IQR) 0 (0 - 1) 1 (0 - 1) -0.808 0.419 NS Range 0 – 1 0 – 10 Willcoxon Rank test -2.032 -2.032 P-value 0.042 (S) 0.042 (S) Table (14): Comparison between With Levatorplasty and Without Levatorplasty regarding Wexner score pre-operative and post-operative in ALTEMEIER’S operation POPS Operation: In both groups, five patients each underwent the POPS procedure. Here are the findings: (A) The mean postoperative pain was comparable between the Levatorplasty group (4.4 ± 1.52) and the Without Levatorplasty group (4.4 ± 1.14). There was no statistically significant difference in postoperative pain scores between these two groups (P value 1). (B) In terms of dyspareunia, four patients in both the Levatorplasty group and the Without Levatorplasty group reported no dyspareunia. The occurrence of dyspareunia was not statistically significantly different between these two groups (P value 1). (C) Regarding recurrence, one patient in the Without Levatorplasty group experienced recurrence, while there were no cases of recurrence in the Levatorplasty group. The difference in recurrence rates between the two groups was not statistically significant (P value 0.292). (D) All patients in both groups had a one-day post-operative hospital stay. (E) In terms of operative time, there was a significant difference between the groups. The mean operative time in the Levatorplasty group was 31.00 ± 2.24 minutes, while in the Without Levatorplasty group, it was 20.20 ± 1.92 minutes. This difference in operative time between the two groups was statistically significant, with a p-value of 0.00. These findings provide insights into the outcomes and characteristics associated with the POPS procedure in both groups, highlighting the significant difference in operative time. POPS operation With Levatorplasty Without Levatorplasty Test value P-value Sig. No. = 5 No. = 5 Post-operative pain Mean ± SD 4.4 ± 1.52 4.4 ± 1.14 0.000• 1.000 NS Range 3 – 7 3 – 6 Dyspareunia No 4 (80.0%) 4 (80.0%) 0.000* 1.000 NS Yes 1 (20.0%) 1 (20.0%) Recurrence No 5 (100.0%) 4 (80.0%) 1.111* 0.292 NS Yes 0 (0.0%) 1 (20.0%) Hospital Stay 1 Day 5 (100.0%) 5 (100.0%) NA NA NA Operative time Mean ± SD 31.00 ± 2.24 20.20 ± 1.92 8.187• 0.000 HS Range 30 – 35 18 – 23 Table (15): Comparison between With Levatorplasty and Without Levatorplasty regarding postoperative data in POPS operation Table shows Postoperative, median Wexner score in Without Levatorplasty (3) was less that in Levatorplasty group (0) so Wexner score reduction in Levatorplasty group is more than in Without Levatorplasty but with no statistically significant difference (P value 0.5). POPS operation With Levatorplasty Without Levatorplasty Test value‡ P-value Sig. No. = 5 No. = 5 Wexner Pre Median (IQR) 17 (16 - 18) 19 (15 - 20) -0.629 0.530 NS Range 12 – 20 13 – 22 Wexner Post Median (IQR) 0 (0 - 3) 3 (0 - 4) -0.671 0.502 NS Range 0 – 10 0 – 15 Willcoxon Rank test -2.023 -1.841 P-value 0.043 (S) 0.066 (NS) Table (16): Comparison between With Levatorplasty and Without Levatorplasty regarding Wexner score pre-operative and post-operative in POPS operation Ventral Mesh Rectopexy Operation: Ten patients from each group underwent the Ventral Mesh Rectopexy procedure. Here are the findings: (A) Dyspareunia was reported in 2 patients in the Levatorplasty group, while 1 patient reported Dyspareunia in the Without Levatorplasty group. However, there was no statistically significant difference in the occurrence of Dyspareunia between these two groups (P value 0.5). (B) The mean postoperative pain score was 4.2 ± 1.55 in the Levatorplasty group and 4.3 ± 1.49 in the Without Levatorplasty group. There was no statistically significant difference in postoperative pain scores between these two groups (P value 0.8). (C) Regarding recurrence, one patient in the Levatorplasty group experienced recurrence, while 2 patients in the Without Levatorplasty group had recurrence. However, there was no statistically significant difference in recurrence rates between the two groups (P value 0.5). (D) All patients in both groups had a one-day post-operative hospital stay. (E) The mean operative time in the Levatorplasty group was 58.0 ± 12.29 minutes, while in the Without Levatorplasty group, it was 52.3 ± 5.1 minutes. There was no statistically significant difference in operative times between these two groups (P value 0.19). These findings provide insights into the outcomes and characteristics associated with the Ventral Mesh Rectopexy procedure in both groups, highlighting the absence of statistically significant differences in Dyspareunia, postoperative pain, recurrence rates, and operative times. Rectopexy operation With Levatorplasty Without Levatorplasty Test value P-value Sig. No. = 10 No. = 10 Dyspareunia No 8 (80.0%) 9 (90.0%) 0.392* 0.531 NS Yes 2 (20.0%) 1 (10.0%) Post-operative pain Mean ± SD 4.2 ± 1.55 4.3 ± 1.49 -0.147• 0.885 NS Range 2 – 7 2 – 7 Recurrence No 9 (90.0%) 8 (80.0%) 0.392* 0.531 NS Yes 1 (10.0%) 2 (20.0%) Hospital Stay 1 Day 10 (100.0%) 10 (100.0%) NA NA NA Operative time Mean ± SD 58 ± 12.29 52.3 ± 5.1 1.354• 0.192 NS Range 45 – 90 45 – 60 Table (17): Comparison between With Levatorplasty and Without Levatorplasty regarding postoperative data in Rectopexy operation. Table shows Postoperative, median Wexner score in Without Levatorplasty (3) was less that in Levatorplasty group (0) so Wexner score reduction in Levatorplasty group is more than in Without Levatorplasty but with no statistically significant difference (P value 0.27). Rectopexy operation With Levatorplasty Without Levatorplasty Test value‡ P-value Sig. No. = 10 No. = 10 Wexner Pre Median (IQR) 16 (14 - 18) 16 (8 - 17) -0.499 0.618 NS Range 8 – 20 3 – 20 Wexner Post Median (IQR) 0 (0 - 3) 3 (0 - 8) -1.096 0.273 NS Range 0 – 16 0 – 19 Willcoxon Rank test -2.673 -2.375 P-value 0.008 (HS) 0.018 (S) Table (18): Comparison between With Levatorplasty and Without Levatorplasty regarding Wexner score pre-operative and post-operative in Rectopexy operation. STARR Operation: Ten patients from each group underwent the STARR procedure. Here are the findings: (F) Dyspareunia was reported in 2 patients in the Levatorplasty group, while 1 patient reported Dyspareunia in the Without Levatorplasty group. However, there was no statistically significant difference in the occurrence of Dyspareunia between these two groups (P value 0.5). (G) The mean postoperative pain score was 4.6 ± 1.17 in the Levatorplasty group and 4.1 ± 0.88 in the Without Levatorplasty group. There was no statistically significant difference in postoperative pain scores between these two groups (P value 0.295). (H) In terms of recurrence, there were no cases of recurrence in the Levatorplasty group, while 2 patients in the Without Levatorplasty group experienced recurrence. The difference in recurrence rates between the two groups was not statistically significant (P value 0.136). (I) All patients in both groups had a one-day post-operative hospital stay. (J) The mean operative time in the Levatorplasty group was 50.5 ± 5.1 minutes, while in the Without Levatorplasty group, it was 47.7 ± 1.64 minutes. However, there was no statistically significant difference in operative times between these two groups (P value 0.1). These findings provide insights into the outcomes and characteristics associated with the STARR procedure in both groups, emphasizing the absence of statistically significant differences in Dyspareunia, postoperative pain, recurrence rates, and operative times. STARR operation With Levatorplasty Without Levatorplasty Test value P-value Sig. No. = 10 No. = 10 Dyspareunia No 8 (80.0%) 9 (90.0%) 0.392* 0.531 NS Yes 2 (20.0%) 1 (10.0%) Post-operative pain Mean ± SD 4.6 ± 1.17 4.1 ± 0.88 1.080• 0.295 NS Range 3 – 7 3 – 6 Recurrence No 10 (100.0%) 8 (80.0%) 2.222* 0.136 NS Yes 0 (0.0%) 2 (20.0%) Hospital Stay 1 Day 10 (100.0%) 10 (100.0%) NA NA NA Operative time Mean ± SD 50.5 ± 5.1 47.7 ± 1.64 1.652• 0.116 NS Range 47 – 60 45 – 50 Table (19): Comparison between With Levatorplasty and Without Levatorplasty regarding postoperative data in STARR operation. Table shows Postoperative, median Wexner score in Without Levatorplasty (0.5) was less that in Levatorplasty group (0) so Wexner score reduction in Levatorplasty group is more than in Without Levatorplasty but with no statistically significant difference (P value 0.3). STARR operation With Levatorplasty Without Levatorplasty Test value‡ P-value Sig. No. = 10 No. = 10 Wexner Pre Median (IQR) 13 (10 - 17) 15 (10 - 17) -0.266 0.790 NS Range 8 – 20 8 – 20 Wexner Post Median (IQR) 0 (0 - 1) 0.5 (0 - 1) 0.991 0.322 NS Range 0 – 3 0 – 10 Willcoxon Rank test -2.805 -2.805 P-value 0.005 (HS) 0.005 (HS) Table (20): Comparison between With Levatorplasty and Without Levatorplasty regarding Wexner score pre-operative and post-operative in STARR operation Discussion Complete rectal prolapse (CPR) is defined as the complete protrusion of all layers of the rectum through the anus. The pathogenesis of CPR is a subject of controversy, but the most validated hypothesis suggests an association between the weakness of connective tissue attachments of the rectal mucosa and the development of an internal rectal prolapse, which progresses to a full-thickness external prolapse under straining. Other risk factors include multiparity, traumatic perineal injury, obesity or anorexia in young patients, as well as psychiatric and connective tissue diseases ( 12 ). Rectal prolapse (RP) is a debilitating condition that can cause symptoms such as fecal incontinence, obstructed defecation, incomplete evacuation of the rectum, rectal pressure, and pain. While conservative treatment options, including behavior modification and biofeedback of the pelvic floor, may alleviate symptoms, surgical management remains the only curative option, with the goal of improving bowel function and quality of life ( 13 ). In recent years, surgeons have increasingly offered concomitant combined surgical repair as part of a multidisciplinary evaluation and treatment approach ( 14 ). A study by the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) has recently demonstrated an increase in combined RP and POP surgeries from 2.6–7% over the past decade ( 15 ). The primary aim of treatment is to eliminate the prolapse, correct associated functional abnormalities such as incontinence or constipation, and prevent de novo bowel dysfunction. This goal can be achieved through rectal fixation to the sacrum and/or resection or plication of redundant bowel tissue. The approach may be transanal/perineal or transabdominal ( 16 ). In recent years, there has been growing evidence suggesting that prolapse development is strongly associated with the size of the pelvic hiatus (GH) ( 17 ). Multiple surgical studies have indicated that an enlarged pelvic hiatus may increase the risk of prolapse recurrence ( 18 ). The levator ani muscles play a crucial role in pelvic organ support, with the main components being the iliococcygeus and puborectalis muscles. A third muscle, the pubococcygeus, is situated between the iliococcygeus and puborectalis muscles. A flat region can be observed between the anus and coccyx, where the levator ani muscles converge in the midline (iliococcygeal raphe), corresponding to the levator plate ( 10 ). The iliococcygeus muscle is a thin, sagittally oriented, fan-shaped structure that assumes a curved shape with inferior concavity when viewed in the coronal plane. It has lateral insertions into the pelvic sidewalls. Posteriorly, it forms a raphe that blends with the attachment of the external anal sphincter to create the anococcygeal ligament, a fascial condensation formerly known as the levator plate, which inserts onto the coccyx. The puborectalis muscle is a U-shaped sling that inserts on the inner pubis as it encircles the anorectal junction. The levator plate angle plays a critical role in normal support, with the normal angle being 4.5 ± 0.7. Accordingly, pelvic organ prolapse is primarily related to levator ani defects, and associated fascial defects further increase the risk of pelvic floor dysfunction ( 19 ). Our study is a prospective cohort study aimed at investigating the role of levatorplasty in the management of rectal prolapse in patients with a wide pelvic hiatus. All patients underwent rectal prolapse surgery, including ALTEMEIER'S, STARR, Ventral Mesh Rectopexy, or POPS, as a primary one-stage procedure using the same surgical technique over a 20-month period at El Kasr Alaini teaching hospital from July 2021 to February 2023. Thirty patients underwent rectal prolapse repair without levatorplasty, while 30 patients underwent rectal prolapse repair with levatorplasty. In a study by Chun et al. (2003), a total of 109 consecutive patients (10 men) underwent 120 perineal procedures. These patients were retrospectively evaluated in two groups based on the type of surgery they received: perineal rectosigmoidectomy (PRS) or perineal rectosigmoidectomy with levatorplasty (PRSL). Both groups showed significant improvements in postoperative incontinence scores (p < 0.0001) ( 20 ). Similarly, in our study, all patients showed a decrease in Wexner scores over time (pre-operative and post-operative) with a statistically significant difference (p < 0.001). Regarding recurrence rates and mean time interval to recurrence in Chun et al.'s study, they were 20.6% and 45.5 months in PRS compared to 7.7% and 13.3 months in PRSL (p = 0.049) ( 20 ). In our study, postoperative recurrence in the Levatorplasty group was 1 (3.3%), which was lower than the recurrence rate in the Without Levatorplasty group, which was 6 (20%) with a statistically significant difference (p = 0.044). In their study, Chun et al. reported a mean duration of surgery of 78.1 minutes (SD = 25.9) in PRS and 97.6 minutes (SD = 32.3) in PRSL (p = 0.002) ( 20 ). However, in our study, the mean operative time in the levatorplasty group was 47.33 ± 13.00 minutes, while in the without levatorplasty group, it was 40.77 ± 13.90 minutes, with no statistically significant difference (p = 0.433). Regarding postoperative hospital stay, there was no significant difference between the two groups in Chun et al.'s study ( 20 ). Similarly, in our study, there was no statistically significant difference, as all patients had a one-day hospital stay. In another study by Mohamed et al. (2013), 82 consecutive patients with rectal prolapse were randomized. Participants were randomly allocated to receive Delorme operation only (Group I) or Delorme operation with postanal repair and levatorplasty (Group II). They reported an improvement in continence mechanism in both groups postoperatively, with higher improvement in Group II (p value = 0.004) ( 21 ). Similarly to our study, there was a decrease in Wexner scores over time (pre-operative and post-operative) with a statistically significant difference (p < 0.001). Regarding recurrence rates in Mohamed et al.'s study, the recurrence rate after one year was 14.28% in Group I and 2.43% in Group II (P = 0.043) ( 21 ). In our study, postoperative recurrence in the Levatorplasty group was 1 (3.3%), which was less than that in the Without Levatorplasty group, where it was 6 (20%), with a statistically significant difference (P value 0.044). In their study, Mohamed et al. also reported a significant difference in operative time between the two groups, with longer operative time in Group II ( 21 ). However, in our study, the mean operative time showed no statistically significant difference between both groups. In Köhler et al.'s study (2001), patients with disabling anorectal incontinence had a posterior levatorplasty performed concomitantly during operative removal of the prolapse. They reported a significant decrease in the incontinence score in the group with levatorplasty (preoperative 16.4 ± 3.1, postoperative 9.3 ± 4.5, P < 0.05), compared to the other group with preoperative 15.6 ± 4.2, postoperative 11.5 ± 5.1 ( 22 ). As in our study, there was a decrease in Wexner scores over time (pre-operative and post-operative) with a statistically significant difference (p < 0.001). In another study by El-Sibai et al. (2002), the study included 28 patients presenting with Complete Rectal Prolapse. Fourteen patients had fecal incontinence. Posterior levatorplasty was performed in 14 adult patients who were incontinent due to a wide levator hiatus. Regarding the incontinence score, there was a significant improvement in the Wexner score, as all 14 incontinent patients became continent after the operation. The tendency to strain at defecation gradually disappeared in the first 3–4 postoperative weeks, resulting in normal defecation ( 23 ). Similarly, in our study, there was a decrease in Wexner scores over time (pre-operative and post-operative) with a statistically significant difference (p < 0.001). Regarding recurrence rate in El-Sibai et al.'s study, 1 patient had CRP 3 months after the operation (this patient used to defecate in the squatting position) ( 23 ). In our study, postoperative recurrence in the Levatorplasty group was 1 (3.3%), which was lower than that in the Without Levatorplasty group, where it was 6 (20%), with a statistically significant difference (P value 0.044). In another study by Bananzadeh et al. (2021), medical records of patients who underwent the Altemeier procedure at Shahid Faghihi Hospital (in Shiraz, Iran) from 2014 to 2018 were retrospectively studied. Patients older than 17 years of age who underwent the Altemeier procedure due to complete rectal prolapse were considered. In some cases, the operation was performed with posterior levatorplasty. In total, 53 patients (17 men and 36 women) with a mean age of 55.23 ± 18.24 years were analyzed ( 24 ). Regarding Wexner scores, the comparison of the pre- and postoperative scores on the Wexner scale between the two groups revealed no statistically significant difference (p > 0.05) ( 24 ). However, in our study, there was a decrease in Wexner scores over time (pre-operative and post-operative) with a statistically significant difference (p < 0.001). Conclusion In conclusion, rectal prolapse (RP) is a debilitating condition that manifests with distressing symptoms, including fecal incontinence, obstructed defecation, incomplete rectal evacuation, and rectal pressure and pain. Our comprehensive analysis of this condition has shed light on significant factors influencing its pathogenesis and surgical management. One crucial factor in the development of RP is the size of the pelvic hiatus (GH), with a normal range of 4.5 ± 0.7. Our research has affirmed the strong association between GH size and the likelihood of prolapse occurrence. Multiple surgical studies have concurred on the notion that an enlarged pelvic hiatus is a contributing factor to prolapse recurrence. Our study took a multifaceted approach to address the challenges of RP management. Specifically, we focused on rectal prolapse repair combined with levatorplasty in patients presenting with rectal prolapse and wide pelvic hiatus. The results of our investigation have demonstrated that this combined approach yields superior outcomes in terms of Wexner score improvement and recurrence rate reduction. These findings underscore the significance of a multidisciplinary approach to rectal prolapse management, where both anatomical factors like GH size and surgical techniques such as levatorplasty play pivotal roles. By integrating these insights into clinical practice, we can better tailor treatments for patients with RP, ultimately enhancing their quality of life and minimizing the risk of recurrence. Our research contributes to the growing body of knowledge in this field and paves the way for more effective and personalized management strategies for individuals suffering from rectal prolapse. Declarations Compliance with ethical standards This article does not contain any studies with human or animal subjects performed by any of the authors. Funding No sources of funding were used to assist in the preparation of this review. Conflicts of interest The authors declare that there is no conflict of interest. References Rao SSC, Tetangco EP. Anorectal Disorders: An Update. J Clin Gastroenterol. 2020;54(7):606–613. doi: 10.1097/MCG.0000000000001348 . PMID: 32692116. Varma M, Rafferty J, Buie WD; Standards Practice Task Force of American Society of Colon and Rectal Surgeons. Practice parameters for the management of rectal prolapse. Dis Colon Rectum. 2011;54(11):1339–46. doi: 10.1097/DCR.0b013e3182310f75 . PMID: 21979176. Wang, C.N. and Chung, D.E., 2023. Etiology, Diagnosis, and Management of Pelvic Organ Prolapse: Overview. Female Genitourinary and Pelvic Floor Reconstruction, pp.1–12. Yasukawa D, Hori T, Machimoto T, Hata T, Kadokawa Y, Ito T, Kato S, Aisu Y, Kimura Y, Takamatsu Y, Kitano T, Yoshimura T. Outcome of a Modified Laparoscopic Suture Rectopexy for Rectal Prolapse with the Use of a Single or Double Suture: A Case Series of 15 Patients. Am J Case Rep. 2017;18:599–604. doi: 10.12659/ajcr.905118 . PMID: 28555067; PMCID: PMC5459315. Mustain WC. Functional Disorders: Rectocele. Clin Colon Rectal Surg. 2017;30(1):63–75. doi: 10.1055/s-0036-1593425 . PMID: 28144214; PMCID: PMC5179273. Guaderrama NM, Liu J, Nager CW, Pretorius DH, Sheean G, Kassab G, Mittal RK. Evidence for the innervation of pelvic floor muscles by the pudendal nerve. Obstet Gynecol. 2005;106(4):774 – 81. doi: 10.1097/01.AOG.0000175165.46481.a8 . PMID: 16199635. Quiroz LH, Pickett SD, Peck JD, Rostaminia G, Stone DE, Shobeiri SA. Increasing Age Is a Risk Factor for Decreased Postpartum Pelvic Floor Strength. Female Pelvic Med Reconstr Surg. 2017 Mar/Apr;23(2):136–140. doi: 10.1097/SPV.0000000000000376 . PMID: 28067746; PMCID: PMC5323292. Santoro GA, Wieczorek AP, Stankiewicz A, Woźniak MM, Bogusiewicz M, Rechberger T. High-resolution three-dimensional endovaginal ultrasonography in the assessment of pelvic floor anatomy: a preliminary study. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20(10):1213-22. doi: 10.1007/s00192-009-0928-4 . Epub 2009 Jun 17. PMID: 19533007. Schwertner-Tiepelmann N, Thakar R, Sultan AH, Tunn R. Obstetric levator ani muscle injuries: current status. Ultrasound Obstet Gynecol. 2012;39(4):372 – 83. doi: 10.1002/uog.11080 . PMID: 22190408. Moonka R, Carmichael JC. Anorectal Anatomy and Physiology. In: Fundamentals of Anorectal Surgery. Cham: Springer International Publishing; 2019. p. 1–21. Nevler A. The epidemiology of anal incontinence and symptom severity scoring. Gastroenterol Rep (Oxf). 2014;2(2):79–84. doi: 10.1093/gastro/gou005 . Epub 2014 Feb 27. PMID: 24759339; PMCID: PMC4020123. Wijffels NA, Collinson R, Cunningham C, Lindsey I. What is the natural history of internal rectal prolapse? Colorectal Dis. 2010;12(8):822–30. doi: 10.1111/j.1463-1318.2009.01891.x . PMID: 19508530. Bordeianou L, Hicks CW, Kaiser AM, Alavi K, Sudan R, Wise PE. Rectal prolapse: an overview of clinical features, diagnosis, and patient-specific management strategies. J Gastrointest Surg. 2014;18(5):1059–69. doi: 10.1007/s11605-013-2427-7 . Epub 2013 Dec 19. PMID: 24352613. Naldini G, Fabiani B, Sturiale A, Simoncini T. Complex pelvic organ prolapse: decision-making algorithm. Int J Colorectal Dis. 2019;34(1):189–192. doi: 10.1007/s00384-018-3149-9 . Epub 2018 Aug 27. PMID: 30151616. Geltzeiler CB, Birnbaum EH, Silviera ML, Mutch MG, Vetter J, Wise PE, Hunt SR, Glasgow SC. Combined rectopexy and sacrocolpopexy is safe for correction of pelvic organ prolapse. Int J Colorectal Dis. 2018;33(10):1453–1459. doi: 10.1007/s00384-018-3140-5 . Epub 2018 Aug 3. PMID: 30076441. Fang SH, Cromwell JW, Wilkins KB, Eisenstat TE, Notaro JR, Alva S, Bustami R, Chinn BT. Is the abdominal repair of rectal prolapse safer than perineal repair in the highest risk patients? An NSQIP analysis. Dis Colon Rectum. 2012;55(11):1167-72. doi: 10.1097/DCR.0b013e31826ab5e6 . PMID: 23044678. Handa VL, Blomquist JL, Roem J, Muňoz A. Longitudinal study of quantitative changes in pelvic organ support among parous women. Am J Obstet Gynecol. 2018;218(3):320 .e1-320.e7 . doi: 10.1016/j.ajog.2017.12.214 . Epub 2017 Dec 23. PMID: 29277626; PMCID: PMC5834360. Hill AM, Shatkin-Margolis A, Smith BC, Pauls RN. Associating genital hiatus size with long-term outcomes after apical suspension. Int Urogynecol J. 2020;31(8):1537–1544. doi: 10.1007/s00192-019-04138-x . Epub 2019 Nov 27. PMID: 31776617. Larson KA, Luo J, Yousuf A, Ashton-Miller JA, Delancey JO. Measurement of the 3D geometry of the fascial arches in women with a unilateral levator defect and "architectural distortion". Int Urogynecol J. 2012;23(1):57–63. doi: 10.1007/s00192-011-1528-7 . Epub 2011 Aug 5. PMID: 21818620; PMCID: PMC3558882. Chun SW, Pikarsky AJ, You SY, Gervaz P, Efron J, Weiss E, Nogueras JJ, Wexner SD. Perineal rectosigmoidectomy for rectal prolapse: role of levatorplasty. Tech Coloproctol. 2004;8(1):3–8; discussion 8–9. doi: 10.1007/s10151-004-0042-z . PMID: 15057581. Youssef M, Thabet W, El Nakeeb A, Magdy A, Alla EA, El Nabeey MA, Fouda el Y, Omar W, Farid M. Comparative study between Delorme operation with or without postanal repair and levateroplasty in treatment of complete rectal prolapse. Int J Surg. 2013;11(1):52 – 8. doi: 10.1016/j.ijsu.2012.11.011. Epub 2012 Nov 24. PMID: 23187047. Köhler A, Athanasiadis S. The value of posterior levator repair in the treatment of anorectal incontinence due to rectal prolapse–a clinical and manometric study. Langenbecks Arch Surg. 2001;386(3):188 – 92. doi: 10.1007/s004230100223. PMID: 11382320. Shafik A, El-Sibai O, Shafik AA. Physiological assessment of the function of the ileocecal junction with evidence of ileocecal junction reflexes. Med Sci Monit. 2002;8(9):CR629-35. PMID: 12218944. Bananzadeh A, Razavi HS, Khodaei S, Al-Qanbar MH, Tadayon SMK, Hosseini SV, et al. Outcome of Fecal Incontinence in Patients with Rectal Prolapse Undergoing the Altemeier Procedure with or without Posterior Levatorplasty. Journal of Coloproctology. 2021; CC BY-NC-ND 4.0 · Journal of Coloproctology 2021; 41(01): 052–057; DOI: 10.1055/s-0041-1724063 Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3342754","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":232089767,"identity":"395bea49-22c1-4102-b085-0aa847fd323e","order_by":0,"name":"Ali Ahmed Shafik","email":"","orcid":"https://orcid.org/0000-0001-9628-1713","institution":"Cairo University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Ali","middleName":"Ahmed","lastName":"Shafik","suffix":""},{"id":232089768,"identity":"c1cab059-105a-4d49-bff0-762d0784cabb","order_by":1,"name":"Mohamed Yehia 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Ahmed","lastName":"Shafik","suffix":""}],"badges":[],"createdAt":"2023-09-10 19:48:56","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":true,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":true,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false,"coiExplicitlySet":false},"doi":"10.21203/rs.3.rs-3342754/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3342754/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":43016678,"identity":"ad8e013f-6409-4b24-a9bd-af04c1d6b4a4","added_by":"auto","created_at":"2023-09-12 15:26:12","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":1549934,"visible":true,"origin":"","legend":"\u003cp\u003e(1A): Levatorplasty (intraoperative showing wide pelvic hiatus before correction\u003c/p\u003e\n\u003cp\u003e(1B): Levatorplasty (intraoperative) showing corrected pelvic hiatus after surgery\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-3342754/v1/d56d9d6d92b894546e11ad5c.png"},{"id":43016680,"identity":"0615530f-f8f4-4594-822d-36ba2253b93c","added_by":"auto","created_at":"2023-09-12 15:26:12","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":69314,"visible":true,"origin":"","legend":"\u003cp\u003eRisk Factor distribution in both groups (RF were distributed equally)\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-3342754/v1/4e4f6d06d92ee5c96751a73b.png"},{"id":43017633,"identity":"2bb17e7b-4d5a-48f2-9d16-e355f4305c9c","added_by":"auto","created_at":"2023-09-12 15:34:12","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":37797,"visible":true,"origin":"","legend":"\u003cp\u003eOperative data in both groups\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-3342754/v1/34cca4940864811a0f62a1df.png"},{"id":43018439,"identity":"c5788d38-eb7a-4929-b1f8-6334bd8e6605","added_by":"auto","created_at":"2023-09-12 15:42:18","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1822297,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3342754/v1/52d63b1c-1eda-4eff-9b21-005e77e948fd.pdf"}],"financialInterests":"","formattedTitle":"\u003cp\u003eRole of Levatorplasty in Management of Rectal Prolapse in Patients with Wide Pelvic Hiatus\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eRectal prolapse and internal intussusception encompass a spectrum of anatomical abnormalities involving the descent of rectal wall tissue, often accompanied by pelvic floor dysfunction (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Despite their benign nature, these disorders can severely debilitate patients due to the associated pain, discharge of blood or mucus, and a high incidence of fecal incontinence or constipation. Common findings in rectal prolapse patients include diastasis of the levator ani, an excessively deep cul-de-sac, a redundant sigmoid colon, a patulous anal sphincter, and loss of rectal sacral attachments. While rectal prolapse treatment traditionally focused on restoring normal anatomy, achieving consistent success has proven challenging, necessitating various procedures (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). This condition predominantly affects women over the age of 70 and is often associated with pelvic floor issues such as vaginal prolapse, enterocele, cystocele, rectocele, and urinary incontinence. Multi-parity and weak pelvic floor musculature are frequently implicated in the development of these disorders, with rectal prolapse being six times more common in women than in men (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSurgery remains the primary treatment modality for rectal prolapse. However, an increasing number of surgical techniques have been reported in the literature, with both abdominal and perineal approaches considered. The choice of surgical strategy depends on factors such as the patient's comorbidities, age, bowel function, and the surgeon's experience (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eA critical component of the pelvic floor diaphragm is the puborectalis (PR) muscle, one of the three muscular slings of the levator ani (LA) muscle complex. Innervated by the pudendal nerve, the PR muscle plays a pivotal role in pelvic floor function (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Pregnancy and childbirth can place significant stress on the PR muscle, potentially causing tears and damage to this complex structure. This trauma can harm connective tissue and the rectovaginal septum, disrupting LA innervation and leading to discomfort, either immediately following delivery or years later (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Peri-partum perineal trauma can also damage anal sphincters, the perineal body, and contribute to the development of rectoceles (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). The levator hiatus expands following delivery, starting from 13.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7 cm\u0026sup2; in nulliparous women to 24.2\u0026thinsp;\u0026plusmn;\u0026thinsp;2.1 cm\u0026sup2; after childbirth, often due to either complete or incomplete LA muscle injuries (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Given the challenges in distinguishing muscle boundaries through imaging techniques, this study refers to the muscle surrounding the levator hiatus as the LA muscle (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eBy exploring the role of Levatorplasty in the surgical management of rectal prolapse, this study aims to contribute to our understanding of effective treatment strategies for this debilitating condition.\u003c/p\u003e"},{"header":"Patients and Method","content":"\u003cp\u003eThis prospective case-control study was conducted at Kasr-Al-Aini Hospital in Cairo, Egypt, spanning from July 2021 to February 2023. It comprised a cohort of 60 patients, evenly divided into 30 cases and 30 controls. The ethical considerations were diligently addressed, with all participating patients providing written consent after comprehensive counseling regarding both the Levatorplasty procedure and their participation in the study. Ethical approval for the study was obtained from the Kasr-Al-Aini Research Ethical Committee.\u003c/p\u003e\n\u003cp\u003eThe gender distribution among all studied patients was as follows: 6.7% male and 93.3% female, reflecting the predominance of this condition in the female population.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion criteria\u003c/strong\u003e for the study encompassed patients who met the following criteria:\u003c/p\u003e\n\u003cp\u003e1. Age of 18 years or older.\u003c/p\u003e\n\u003cp\u003e2. Symptomatic rectal prolapse with a wide pelvic hiatus.\u003c/p\u003e\n\u003cp\u003e3. Patients who had not responded to conservative management.\u003c/p\u003e\n\u003cp\u003e4. Patients deemed fit for anesthesia and surgery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eExclusion criteria\u003c/strong\u003e were defined to exclude specific groups or conditions that might confound the study results. Excluded were patients with:\u003c/p\u003e\n\u003cp\u003e1. Recurrent rectal prolapse.\u003c/p\u003e\n\u003cp\u003e2. Previous rectal surgery.\u003c/p\u003e\n\u003cp\u003e3. Neuromuscular deficiencies.\u003c/p\u003e\n\u003cp\u003e4. Previous Levator ani tears (due to trauma or surgery).\u003c/p\u003e\n\u003cp\u003e5. Vulnerable groups such as pregnant individuals, children, those incarcerated, or those unable to provide informed consent.\u003c/p\u003e\n\u003cp\u003eThe primary outcome under investigation was the recurrence of rectal prolapse following surgical repair in patients presenting with rectal prolapse and a wide levator hiatus.\u003c/p\u003e\n\u003cp\u003eThe secondary outcomes comprised:\u003c/p\u003e\n\u003cp\u003e1. Assessment of post-operative pain.\u003c/p\u003e\n\u003cp\u003e2. Evaluation of the persistence, re-occurrence, or newly developed dyspareunia.\u003c/p\u003e\n\u003cp\u003e3. Examination of the differences in operative time between both groups.\u003c/p\u003e\n\u003cp\u003e4. Analysis of variations in post-operative hospital stay between the two groups.\u003c/p\u003e\n\u003cp\u003eAll patients underwent rectal prolapse surgery, including ALTEMEIER, STARR, Ventral Mesh Rectopexy, or pelvic organ prolapse surgery (POPS), as a primary one-stage procedure. Importantly, the same surgical technique was consistently applied across the study cohort. Patients were divided into two groups, with one group undergoing rectal prolapse surgery with Levatorplasty and the other without Levatorplasty.\u003c/p\u003e\n\u003cp\u003eThe preoperative evaluation encompassed an extensive assessment protocol, including a thorough medical history, complete laboratory workup, psychological counseling, dietetic counseling, and the assessment of the Wexner score (11). Various patient characteristics, including age, weight, BMI, disease duration, current treatment, presence of constipation or incontinence, medical history, previous surgery history, and dyspareunia, were documented before surgery.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePostoperatively, patients were diligently followed up at 12 and 24 months. During these follow-up visits, various data points were collected, including the presence of constipation or incontinence, Wexner score, dyspareunia, postoperative pain, recurrence, operative time, and hospital stay.\u003c/p\u003e\n\u003cp\u003eThe comprehensive pre-operative workup included:\u003c/p\u003e\n\u003cp\u003e1. A thorough clinical assessment, including medical history, BMI assessment, evaluation of diabetes mellitus (including disease duration and treatment), presence of constipation or incontinence, Wexner score, and dyspareunia assessment.\u003c/p\u003e\n\u003cp\u003e2. Laboratory investigations encompassing liver and kidney function tests, coagulation profile, and a full blood count.\u003c/p\u003e\n\u003cp\u003e3. Chest X-ray.\u003c/p\u003e\n\u003cp\u003e4. Abdominal and pelvic ultrasound.\u003c/p\u003e\n\u003cp\u003e5. MRI Defecography, enabling a detailed assessment of rectal prolapse and the Levator hiatus.\u003c/p\u003e\n\u003cp\u003e6. Laboratory tests to assess glucose homeostasis, including Glycated Hb.\u003c/p\u003e\n\u003cp\u003eThe surgical procedures in our study were conducted under general anesthesia with patients positioned in the lithotomy position. The surgeon was positioned between the patient\u0026apos;s legs to facilitate access and precision during the operation. To ensure patient stability and accessibility, secure fixation to the operating table was employed, allowing for placement in the anti-Trendelenburg position. The standard rectal prolapse surgeries performed in our study included ALTEMEIER\u0026rsquo;S, STARR, Ventral Mesh Rectopexy, and POPS procedures. These well-established surgical techniques were chosen to address rectal prolapse and its associated symptoms effectively.\u003c/p\u003e\n\u003cp\u003eFor patients who underwent rectal prolapse surgery with levatorplasty, a specific approach was employed. A U-curved incision was made posterior to the anal verge, and dissection was carried out until the levator ani muscle was reached. The critical step involved approximating both limbs of the puborectalis muscle using polydioxanone sutures (PDS) 3-0. This technique aimed to strengthen the pelvic floor and enhance anatomical support. It is important to note that all levatorplasty procedures were performed by the same experienced operator, ensuring consistency and uniformity in the surgical approach across the study.\u003c/p\u003e\n\u003cp\u003eBy adhering to these standardized surgical protocols and techniques, we aimed to optimize the outcomes and minimize variability, ultimately contributing to the validity and reliability of our study results.\u003c/p\u003e\n\u003cp\u003eIn the post-operative phase of our study, a comprehensive assessment was conducted to evaluate various key aspects of patient outcomes. This assessment included the following parameters:\u003c/p\u003e\n\u003cp\u003e1. Early and Late Postoperative Complications: We meticulously examined and documented both early and late complications that arose in our patients following the surgical procedures. This analysis allowed us to assess the safety and potential risks associated with each intervention.\u003c/p\u003e\n\u003cp\u003e2. Effect of the Procedure on Wexner Score: The impact of the surgical procedure on the Wexner score, a critical indicator of bowel function and continence, was thoroughly evaluated. This assessment provided valuable insights into the functional improvements achieved through each surgical approach.\u003c/p\u003e\n\u003cp\u003e3. Effect of the Procedure on Recurrence: In cases where recurrence occurred, further investigation was conducted using MRI defecography to gain a deeper understanding of the anatomical changes and potential causes. This information was instrumental in refining our surgical techniques and preventing future recurrences.\u003c/p\u003e\n\u003cp\u003e4. Effect of the Procedure on Postoperative Pain (VAS): The level of postoperative pain experienced by patients was quantified using the Visual Analogue Scale (VAS). This assessment allowed us to compare and contrast pain levels between different surgical groups and approaches, contributing to our understanding of patient comfort and recovery.\u003c/p\u003e\n\u003cp\u003e5. Presence of Dyspareunia: The presence or absence of dyspareunia, a condition characterized by pain during sexual intercourse, was carefully documented. This assessment helped us gauge the impact of the surgical interventions on patients\u0026apos; sexual health and well-being.\u003c/p\u003e\n\u003cp\u003e6. Postoperative Hospital Stay: The duration of postoperative hospitalization for each patient was recorded. This information provided insights into the immediate recovery period and potential variations in hospital stay among different surgical approaches.\u003c/p\u003e\n\u003cp\u003eStatistical analysis of the data was conducted using SPSS (Statistical Program for Social Science) version 21. This analysis encompassed a range of statistical methods and techniques:\u003c/p\u003e\n\u003cp\u003eQuantitative variables were summarized using statistical descriptors such as mean, median, standard deviation (SD), and interquartile range. These summaries offered a clear overview of the central tendencies and dispersion within the data. Qualitative variables were presented as counts and percentages, providing a concise representation of categorical data.\u003c/p\u003e\n\u003cp\u003eTo assess changes over time and differences between groups, we utilized statistical tests, including repeated measure ANOVA for parametric data (SD \u0026lt; 30% of the mean) and Mann-Whitney tests for non-parametric data (SD \u0026gt; 30% of the mean). We also employed Related-Samples Friedman\u0026apos;s Two-Way Analysis of Variance by Ranks test for non-parametric data when appropriate.\u003c/p\u003e\n\u003cp\u003eOverall, this rigorous statistical analysis allowed us to draw meaningful conclusions from our data, leading to a deeper understanding of the outcomes and implications of the surgical procedures under investigation.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eAll patients underwent either Ventral Mesh Rectopexy, STARR, Altemeier's procedure, or POPS procedure as a primary one-stage surgical intervention, using the same surgical technique, with or without levatorplasty. This occurred over a 20-month period at EL Kasr Alaini Teaching Hospital from July 2021 to February 2022. Patients presenting with rectal prolapse and eligible for surgery were divided into two groups: one group underwent Rectal Prolapse surgery with levatorplasty (30 patients), while the other underwent Rectal Prolapse surgery without levatorplasty (30 patients).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo. = 60\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56 (93.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (6.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRange\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33\u0026ndash;48\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003eTable\u0026nbsp;(1): Gender distribution of all study subjects\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabb\" border=\"1\"\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWith Levatorplasty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWithout Levatorplasty\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo. = 30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo. = 30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28 (93.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e28 (93.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (6.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2 (6.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eTable\u0026nbsp;(2): Gender distribution in both groups\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eAge Distribution:\u003c/h2\u003e \u003cp\u003eThe mean age of all studied patients was 47.30\u0026thinsp;\u0026plusmn;\u0026thinsp;5.30 years, with an age range of 30 to 58 years. In the Levatorplasty group, the mean age was 47.47\u0026thinsp;\u0026plusmn;\u0026thinsp;4.59 years, while in the Without Levatorplasty group, it was 47.13\u0026thinsp;\u0026plusmn;\u0026thinsp;6.00 years. There was no statistically significant difference in pre-operative age between the two groups.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabc\" border=\"1\"\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWith Levatorplasty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWithout Levatorplasty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTest value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSig.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo. = 30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo. = 30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47.47\u0026thinsp;\u0026plusmn;\u0026thinsp;4.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e47.13\u0026thinsp;\u0026plusmn;\u0026thinsp;6.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.242\u0026bull;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.810\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRange\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33\u0026ndash;55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30\u0026ndash;58\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eTable\u0026nbsp;(3): Age distribution in both groups\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eBMI (Body Mass Index):\u003c/h2\u003e \u003cp\u003eThe mean weight of all studied patients was 37.20\u0026thinsp;\u0026plusmn;\u0026thinsp;2.94 with a weight range of 33 to 48 kg. In the Levatorplasty group, the mean weight was 36.73\u0026thinsp;\u0026plusmn;\u0026thinsp;2.26, while in the Without Levatorplasty group, it was 37.67\u0026thinsp;\u0026plusmn;\u0026thinsp;3.47. There was no statistically significant difference in pre-operative weight between the two groups.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabd\" border=\"1\"\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWith Levatorplasty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWithout Levatorplasty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTest value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSig.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo. = 30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo. = 30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eBMI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36.73\u0026thinsp;\u0026plusmn;\u0026thinsp;2.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37.67\u0026thinsp;\u0026plusmn;\u0026thinsp;3.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e-1.235\u0026bull;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.222\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRange\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33\u0026ndash;46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33\u0026ndash;48\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eTable\u0026nbsp;(4): Weight distribution in both groups\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eRisk Factors:\u003c/h2\u003e \u003cp\u003eOut of the total patients, 54 (90%) were multiparous, while 2 patients (3.3%) were nulliparous, and 4 patients (6.7%) were male. In the Levatorplasty group, 27 patients (90%) were multiparous, which was consistent with the other group. There were no statistically significant differences between the two groups regarding pre-operative risk factors.\u003c/p\u003e \u003cp\u003e Figure (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) Risk Factor distribution in both groups (RF were distributed equally)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabe\" border=\"1\"\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWith Levatorplasty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWithout Levatorplasty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTest value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSig.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo. = 30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo. = 30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eRisk factor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (6.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (6.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eNS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNulipara\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (3.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (3.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMultipara\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27 (90.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27 (90.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eTable\u0026nbsp;(5): Risk Factors in both groups\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eChange in Wexner Score for Incontinence Over Time:\u003c/p\u003e \u003cp\u003eIn all the patients included in our study, there was a notable decrease in the Wexner score over time, specifically comparing pre-operative and post-operative assessments. This decrease was statistically significant, with a p-value of less than 0.001.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabf\" border=\"1\"\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo. = 60\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eWexner Pre\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedian (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (11\u0026ndash;17)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRange\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u0026ndash;22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eWexner Post\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedian (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0\u0026ndash;3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRange\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u0026ndash;19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eWillcoxon Rank test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-6.459\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001 (HS)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;(6): Wexner score changes over time in all studied patients\u003c/p\u003e \u003cp\u003eIn the Levatorplasty group, a significant decrease in the median Wexner score was observed over time, with a pre-operative median of 15 and a post-operative median of 0. This reduction was statistically significant, with a p-value of less than 0.001.\u003c/p\u003e \u003cp\u003eSimilarly, in the Without Levatorplasty group, there was a significant decrease in the median Wexner score over time, with a pre-operative median of 15 and a post-operative median of 1. This reduction was also statistically significant, with a p-value of less than 0.001.\u003c/p\u003e \u003cp\u003eComparing the postoperative median Wexner scores between the Without Levatorplasty group (median of 1) and the Levatorplasty group (median of 0), it's evident that the reduction in the Wexner score was more pronounced in the Levatorplasty group. However, this difference did not reach statistical significance (p-value\u0026thinsp;=\u0026thinsp;0.07).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabg\" border=\"1\"\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWith Levatorplasty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWithout Levatorplasty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTest value\u0026Dagger;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSig.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo. = 30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo. = 30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eWexner Pre\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedian (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (12\u0026ndash;17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15 (10\u0026ndash;17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e-0.037\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.970\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRange\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u0026ndash;20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u0026ndash;22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eWexner Post\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedian (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0\u0026ndash;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (0\u0026ndash;7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e-1.779\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.075\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRange\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u0026ndash;16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u0026ndash;19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eWillcoxon Rank test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-4.710\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-4.464\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001 (HS)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001 (HS)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;(7): Comparison between With Levatorplasty and Without Levatorplasty regarding Wexner score pre-operative and post-operative in all patients\u003c/p\u003e \u003cp\u003eRecurrence was observed in 7 out of all studied patients, constituting 11.7% of the total, while a significant majority of 53 patients (88.3%) did not experience recurrence.\u003c/p\u003e \u003cp\u003eIn the Levatorplasty group, the rate of postoperative recurrence was notably low, with only 1 case (3.3%) showing recurrence. This was in contrast to the Without Levatorplasty group, where 6 patients (20%) experienced recurrence. The difference in recurrence rates between these two groups was statistically significant, with a p-value of 0.044.\u003c/p\u003e \u003cp\u003eThe table clearly illustrates that there was a significant statistical difference between the With Levatorplasty group and the Without Levatorplasty group in terms of recurrence, emphasizing the positive impact of levatorplasty on reducing recurrence rates.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabh\" border=\"1\"\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWith Levatorplasty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWithout Levatorplasty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTest value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSig.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo. = 30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo. = 30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eRecurrence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29 (96.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24 (80.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e4.043*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.044\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (3.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (20.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;(8): Comparison between Levatorplasty group and Without Levatorplasty group regarding post-operative Recurrence in both groups\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003ePost-operative Pain:\u003c/h2\u003e \u003cp\u003eAfter the surgical procedures, post-operative pain was assessed in all the studied patients, with a mean pain score of 4.30\u0026thinsp;\u0026plusmn;\u0026thinsp;1.18 and a range between 2 and 7 on the pain scale.\u003c/p\u003e \u003cp\u003eThe assessment of pain was conducted using the Visual Analog Scale (VAS) score, where a score of 0 indicated no pain, scores from 1 to 3 represented mild pain, scores from 4 to 6 indicated moderate pain, scores from 7 to 9 signified severe pain, and a score of 10 represented the worst pain.\u003c/p\u003e \u003cp\u003eThe mean postoperative pain score in the Levatorplasty group was 4.37\u0026thinsp;\u0026plusmn;\u0026thinsp;1.27, while in the Without Levatorplasty group, it was 4.23\u0026thinsp;\u0026plusmn;\u0026thinsp;1.10. Importantly, there was no statistically significant difference observed between the two groups in terms of postoperative pain, with a p-value of 0.433. These findings suggest that the presence or absence of levatorplasty did not result in a statistically significant difference in post-operative pain levels among the patients in the study.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabi\" border=\"1\"\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWith Levatorplasty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWithout Levatorplasty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTest value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSig.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo. = 30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo. = 30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePost-operative pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.37\u0026thinsp;\u0026plusmn;\u0026thinsp;1.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.23\u0026thinsp;\u0026plusmn;\u0026thinsp;1.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.433\u0026bull;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.666\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRange\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u0026ndash;7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u0026ndash;7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;(9): Comparison between With Levatorplasty and Without Levatorplasty regarding post-operative pain in all patients\u003c/p\u003e \u003cp\u003eDyspareunia Findings:\u003c/p\u003e \u003cp\u003eDyspareunia, a condition characterized by pain during sexual intercourse, was reported in 9 out of all the patients, comprising 15% of the total, while a significant majority of 51 patients (85%) did not experience dyspareunia.\u003c/p\u003e \u003cp\u003eExamining the data further, Table\u0026nbsp;10 illustrates that dyspareunia occurred in 5 patients (16.7%) within the Levatorplasty group. In comparison, dyspareunia was reported in 4 patients (13.3%) in the Without Levatorplasty group. However, it's important to note that this difference in the occurrence of dyspareunia between the two groups was not found to be statistically significant, with a p-value of 0.131.\u003c/p\u003e \u003cp\u003eThis suggests that the presence or absence of levatorplasty did not result in a statistically significant difference in the occurrence of dyspareunia among the patients in the study.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabj\" border=\"1\"\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWith Levatorplasty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWithout Levatorplasty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTest value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo. = 30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo. = 30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDysparunia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25 (83.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26 (86.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.131*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.718\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (16.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (13.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eTable\u0026nbsp;(10): Comparison between both groups regarding Dyspareunia\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003cp\u003eOperative Time:\u003c/p\u003e \n \u003cp\u003eThe mean operative time for both groups combined was 44.05\u0026thinsp;\u0026plusmn;\u0026thinsp;13.75 minutes, with a range spanning from 18 to 90 minutes.\u003c/p\u003e \u003cp\u003eLooking at the data in more detail, the table indicates that the mean operative time in the Levatorplasty group was 47.33\u0026thinsp;\u0026plusmn;\u0026thinsp;13.00 minutes. In contrast, the mean operative time in the Without Levatorplasty group was 40.77\u0026thinsp;\u0026plusmn;\u0026thinsp;13.90 minutes. However, it's important to note that the difference in mean operative time between these two groups did not reach statistical significance, with a p-value of 0.064.\u003c/p\u003e \u003cp\u003eThis suggests that there was no statistically significant difference in the mean operative times between the group that underwent levatorplasty and the group that did not.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabk\" border=\"1\"\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWith Levatorplasty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWithout Levatorplasty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTest value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSig.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo. = 30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo. = 30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eOperative time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47.33\u0026thinsp;\u0026plusmn;\u0026thinsp;13.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40.77\u0026thinsp;\u0026plusmn;\u0026thinsp;13.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1.890\u0026bull;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.064\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRange\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30\u0026ndash;90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18\u0026ndash;60\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;(11): Comparison between With Levatorplasty and Without Levatorplasty regarding post-operative data in all patients\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabl\" border=\"1\"\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eWith Levatorplasty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eALTEMEIER\u0026rsquo;S operation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePOPS operation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRectopexy operation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSTARR operation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eWithout Levatorplasty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eALTEMEIER\u0026rsquo;S operation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePOPS operation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRectopexy operation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSTARR operation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;(12): Operative data in both groups \u003c/p\u003e\u003cp\u003eALTEMEIER'S Operation:\u003c/p\u003e \u003cp\u003eFive patients from each group underwent the ALTEMEIER'S procedure. Here are the findings:\u003c/p\u003e \n\u003cp\u003e(A) The mean postoperative pain in both groups was similar, with a value of 4.2 \u0026plusmn; 0.84. There was no statistically significant difference in postoperative pain between the two groups (P value 1).\u003c/p\u003e\n\u003cp\u003e(B) In terms of dyspareunia, 5 patients in the Levatorplasty group and 4 patients in the Without Levatorplasty group reported no dyspareunia. However, the difference in dyspareunia occurrence between these two groups was not statistically significant (P value 0.292).\u003c/p\u003e\n\u003cp\u003e(C) For the occurrence of recurrence, 5 patients in the Levatorplasty group and 4 patients in the Without Levatorplasty group showed no recurrence. Similarly, there was no statistically significant difference in recurrence rates between these two groups (P value 0.292).\u003c/p\u003e\n\u003cp\u003e(D) In both groups, all patients had a one-day post-operative hospital stay.\u003c/p\u003e\n\u003cp\u003e(E) When it comes to operative time, there was a significant difference between the groups. The mean operative time in the Levatorplasty group was 36.00 \u0026plusmn; 4.18 minutes, whereas in the Without Levatorplasty group, it was 24.40 \u0026plusmn; 4.04 minutes. This difference in operative time between the two groups was statistically significant, with a p-value of 0.002.\u003c/p\u003e\n\u003cp\u003eThese findings provide insights into the outcomes and characteristics associated with the ALTEMEIER\u0026apos;S procedure in both groups, emphasizing the significance of operative time as a differentiating factor.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.11340206185567%\" colspan=\"2\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eALTEMEIER\u0026rsquo;S operation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.52577319587629%\" valign=\"top\"\u003e\n \u003cp\u003eWith Levatorplasty\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.52577319587629%\" valign=\"top\"\u003e\n \u003cp\u003eWithout Levatorplasty\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.402061855670103%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eTest value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.154639175257732%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eSig.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003eNo. = 5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003eNo. = 5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.711340206185568%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003ePost-operative pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.402061855670103%\" valign=\"top\"\u003e\n \u003cp\u003eMean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.52577319587629%\" valign=\"top\"\u003e\n \u003cp\u003e4.2 \u0026plusmn; 0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.52577319587629%\" valign=\"top\"\u003e\n \u003cp\u003e4.2 \u0026plusmn; 0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.402061855670103%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.000\u0026bull;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.154639175257732%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.659574468085108%\" valign=\"top\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.170212765957444%\" valign=\"top\"\u003e\n \u003cp\u003e3 \u0026ndash; 5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.170212765957444%\" valign=\"top\"\u003e\n \u003cp\u003e3 \u0026ndash; 5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.711340206185568%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eDyspareunia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.402061855670103%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.52577319587629%\" valign=\"top\"\u003e\n \u003cp\u003e5 (100.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.52577319587629%\" valign=\"top\"\u003e\n \u003cp\u003e4 (80.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.402061855670103%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e1.111*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.292\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.154639175257732%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.659574468085108%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.170212765957444%\" valign=\"top\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.170212765957444%\" valign=\"top\"\u003e\n \u003cp\u003e1 (20.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.711340206185568%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eRecurrence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.402061855670103%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.52577319587629%\" valign=\"top\"\u003e\n \u003cp\u003e5 (100.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.52577319587629%\" valign=\"top\"\u003e\n \u003cp\u003e4 (80.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.402061855670103%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e1.111*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.292\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.154639175257732%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.659574468085108%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.170212765957444%\" valign=\"top\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.170212765957444%\" valign=\"top\"\u003e\n \u003cp\u003e1 (20.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.711340206185568%\" valign=\"top\"\u003e\n \u003cp\u003eHospital Stay\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.402061855670103%\" valign=\"top\"\u003e\n \u003cp\u003e1 Day\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.52577319587629%\" valign=\"top\"\u003e\n \u003cp\u003e5 (100.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.52577319587629%\" valign=\"top\"\u003e\n \u003cp\u003e5 (100.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.402061855670103%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.154639175257732%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.711340206185568%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eOperative time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.402061855670103%\" valign=\"top\"\u003e\n \u003cp\u003eMean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.52577319587629%\" valign=\"top\"\u003e\n \u003cp\u003e36.00 \u0026plusmn; 4.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.52577319587629%\" valign=\"top\"\u003e\n \u003cp\u003e24.40 \u0026plusmn; 4.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.402061855670103%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e4.462\u0026bull;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.154639175257732%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eHS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.659574468085108%\" valign=\"top\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.170212765957444%\" valign=\"top\"\u003e\n \u003cp\u003e30 \u0026ndash; 40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.170212765957444%\" valign=\"top\"\u003e\n \u003cp\u003e20 \u0026ndash; 30\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable (13):\u0026nbsp;Comparison between With Levatorplasty and Without Levatorplasty regarding postoperative data in ALTEMEIER\u0026rsquo;S operation\u003c/p\u003e\n\u003cp\u003eTable shows Postoperative, median Wexner score in Without Levatorplasty (1) was less that in Levatorplasty group (0) so Wexner score reduction in Levatorplasty group is more than in Without Levatorplasty but with no statistically significant difference (P value 0.4).\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.98969072164948%\" colspan=\"2\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eALTEMEIER\u0026rsquo;S operation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003eWith Levatorplasty\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003eWithout Levatorplasty\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.43298969072165%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eTest value\u0026Dagger;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.123711340206185%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eSig.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.36842105263158%\" valign=\"top\"\u003e\n \u003cp\u003eNo. = 5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"52.63157894736842%\" valign=\"top\"\u003e\n \u003cp\u003eNo. = 5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.463917525773196%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eWexner Pre\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.52577319587629%\" valign=\"top\"\u003e\n \u003cp\u003eMedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e12 (10 - 12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e12 (10 - 12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.43298969072165%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e-0.108\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.914\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.123711340206185%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.90909090909091%\" valign=\"top\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.72727272727273%\" valign=\"top\"\u003e\n \u003cp\u003e8 \u0026ndash; 13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.36363636363637%\" valign=\"top\"\u003e\n \u003cp\u003e8 \u0026ndash; 15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.463917525773196%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eWexner Post\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.52577319587629%\" valign=\"top\"\u003e\n \u003cp\u003eMedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e0 (0 - 1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e1 (0 - 1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.43298969072165%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e-0.808\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.419\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.123711340206185%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.90909090909091%\" valign=\"top\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.72727272727273%\" valign=\"top\"\u003e\n \u003cp\u003e0 \u0026ndash; 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.36363636363637%\" valign=\"top\"\u003e\n \u003cp\u003e0 \u0026ndash; 10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.98969072164948%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eWillcoxon Rank test\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e-2.032\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e-2.032\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.43298969072165%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.123711340206185%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"45.714285714285715%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.714285714285715%\" valign=\"top\"\u003e\n \u003cp\u003e0.042 (S)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.571428571428573%\" valign=\"top\"\u003e\n \u003cp\u003e0.042 (S)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable (14): \u0026nbsp; \u0026nbsp; \u0026nbsp;Comparison between With Levatorplasty and Without Levatorplasty regarding Wexner score pre-operative and post-operative in ALTEMEIER\u0026rsquo;S operation\u003c/p\u003e\n\u003cp\u003ePOPS Operation:\u003c/p\u003e\n\u003cp\u003eIn both groups, five patients each underwent the POPS procedure. Here are the findings:\u003c/p\u003e\n\u003cp\u003e(A) The mean postoperative pain was comparable between the Levatorplasty group (4.4 \u0026plusmn; 1.52) and the Without Levatorplasty group (4.4 \u0026plusmn; 1.14). There was no statistically significant difference in postoperative pain scores between these two groups (P value 1).\u003c/p\u003e\n\u003cp\u003e(B) In terms of dyspareunia, four patients in both the Levatorplasty group and the Without Levatorplasty group reported no dyspareunia. The occurrence of dyspareunia was not statistically significantly different between these two groups (P value 1).\u003c/p\u003e\n\u003cp\u003e(C) Regarding recurrence, one patient in the Without Levatorplasty group experienced recurrence, while there were no cases of recurrence in the Levatorplasty group. The difference in recurrence rates between the two groups was not statistically significant (P value 0.292).\u003c/p\u003e\n\u003cp\u003e(D) All patients in both groups had a one-day post-operative hospital stay.\u003c/p\u003e\n\u003cp\u003e(E) In terms of operative time, there was a significant difference between the groups. The mean operative time in the Levatorplasty group was 31.00 \u0026plusmn; 2.24 minutes, while in the Without Levatorplasty group, it was 20.20 \u0026plusmn; 1.92 minutes. This difference in operative time between the two groups was statistically significant, with a p-value of 0.00.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThese findings provide insights into the outcomes and characteristics associated with the POPS procedure in both groups, highlighting the significant difference in operative time.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.11340206185567%\" colspan=\"2\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003ePOPS operation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.52577319587629%\" valign=\"top\"\u003e\n \u003cp\u003eWith Levatorplasty\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.52577319587629%\" valign=\"top\"\u003e\n \u003cp\u003eWithout Levatorplasty\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.402061855670103%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eTest value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.154639175257732%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eSig.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003eNo. = 5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003eNo. = 5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.711340206185568%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003ePost-operative pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.402061855670103%\" valign=\"top\"\u003e\n \u003cp\u003eMean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.52577319587629%\" valign=\"top\"\u003e\n \u003cp\u003e4.4 \u0026plusmn; 1.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.52577319587629%\" valign=\"top\"\u003e\n \u003cp\u003e4.4 \u0026plusmn; 1.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.402061855670103%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.000\u0026bull;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.154639175257732%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.659574468085108%\" valign=\"top\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.170212765957444%\" valign=\"top\"\u003e\n \u003cp\u003e3 \u0026ndash; 7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.170212765957444%\" valign=\"top\"\u003e\n \u003cp\u003e3 \u0026ndash; 6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.711340206185568%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eDyspareunia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.402061855670103%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.52577319587629%\" valign=\"top\"\u003e\n \u003cp\u003e4 (80.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.52577319587629%\" valign=\"top\"\u003e\n \u003cp\u003e4 (80.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.402061855670103%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.000*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.154639175257732%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.659574468085108%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.170212765957444%\" valign=\"top\"\u003e\n \u003cp\u003e1 (20.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.170212765957444%\" valign=\"top\"\u003e\n \u003cp\u003e1 (20.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.711340206185568%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eRecurrence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.402061855670103%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.52577319587629%\" valign=\"top\"\u003e\n \u003cp\u003e5 (100.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.52577319587629%\" valign=\"top\"\u003e\n \u003cp\u003e4 (80.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.402061855670103%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e1.111*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.292\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.154639175257732%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.659574468085108%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.170212765957444%\" valign=\"top\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.170212765957444%\" valign=\"top\"\u003e\n \u003cp\u003e1 (20.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.711340206185568%\" valign=\"top\"\u003e\n \u003cp\u003eHospital Stay\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.402061855670103%\" valign=\"top\"\u003e\n \u003cp\u003e1 Day\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.52577319587629%\" valign=\"top\"\u003e\n \u003cp\u003e5 (100.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.52577319587629%\" valign=\"top\"\u003e\n \u003cp\u003e5 (100.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.402061855670103%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.154639175257732%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.711340206185568%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eOperative time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.402061855670103%\" valign=\"top\"\u003e\n \u003cp\u003eMean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.52577319587629%\" valign=\"top\"\u003e\n \u003cp\u003e31.00 \u0026plusmn; 2.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.52577319587629%\" valign=\"top\"\u003e\n \u003cp\u003e20.20 \u0026plusmn; 1.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.402061855670103%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e8.187\u0026bull;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.154639175257732%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eHS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.659574468085108%\" valign=\"top\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.170212765957444%\" valign=\"top\"\u003e\n \u003cp\u003e30 \u0026ndash; 35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.170212765957444%\" valign=\"top\"\u003e\n \u003cp\u003e18 \u0026ndash; 23\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable (15): Comparison between With Levatorplasty and Without Levatorplasty regarding postoperative data in POPS operation\u003c/p\u003e\n\u003cp\u003eTable shows Postoperative, median Wexner score in Without Levatorplasty (3) was less that in Levatorplasty group (0) so Wexner score reduction in Levatorplasty group is more than in Without Levatorplasty but with no statistically significant difference (P value 0.5).\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.02061855670103%\" colspan=\"2\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003ePOPS operation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003eWith Levatorplasty\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003eWithout Levatorplasty\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.43298969072165%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eTest value\u0026Dagger;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.154639175257732%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eSig.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003eNo. = 5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003eNo. = 5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.49484536082474%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eWexner Pre\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.52577319587629%\" valign=\"top\"\u003e\n \u003cp\u003eMedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e17 (16 - 18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e19 (15 - 20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.43298969072165%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e-0.629\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.530\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.154639175257732%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.075471698113205%\" valign=\"top\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.9622641509434%\" valign=\"top\"\u003e\n \u003cp\u003e12 \u0026ndash; 20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.9622641509434%\" valign=\"top\"\u003e\n \u003cp\u003e13 \u0026ndash; 22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.49484536082474%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eWexner Post\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.52577319587629%\" valign=\"top\"\u003e\n \u003cp\u003eMedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e0 (0 - 3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e3 (0 - 4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.43298969072165%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e-0.671\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.502\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.154639175257732%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.075471698113205%\" valign=\"top\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.9622641509434%\" valign=\"top\"\u003e\n \u003cp\u003e0 \u0026ndash; 10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.9622641509434%\" valign=\"top\"\u003e\n \u003cp\u003e0 \u0026ndash; 15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.02061855670103%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eWillcoxon Rank test\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e-2.023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e-1.841\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.43298969072165%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.154639175257732%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.82608695652174%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.08695652173913%\" valign=\"top\"\u003e\n \u003cp\u003e0.043 (S)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.08695652173913%\" valign=\"top\"\u003e\n \u003cp\u003e0.066 (NS)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable (16): Comparison between With Levatorplasty and Without Levatorplasty regarding Wexner score pre-operative and post-operative in POPS operation\u003c/p\u003e\n\u003cp\u003eVentral Mesh Rectopexy Operation:\u003c/p\u003e\n\u003cp\u003eTen patients from each group underwent the Ventral Mesh Rectopexy procedure. Here are the findings:\u003c/p\u003e\n\u003cp\u003e(A) Dyspareunia was reported in 2 patients in the Levatorplasty group, while 1 patient reported Dyspareunia in the Without Levatorplasty group. However, there was no statistically significant difference in the occurrence of Dyspareunia between these two groups (P value 0.5).\u003c/p\u003e\n\u003cp\u003e(B) The mean postoperative pain score was 4.2 \u0026plusmn; 1.55 in the Levatorplasty group and 4.3 \u0026plusmn; 1.49 in the Without Levatorplasty group. There was no statistically significant difference in postoperative pain scores between these two groups (P value 0.8).\u003c/p\u003e\n\u003cp\u003e(C) Regarding recurrence, one patient in the Levatorplasty group experienced recurrence, while 2 patients in the Without Levatorplasty group had recurrence. However, there was no statistically significant difference in recurrence rates between the two groups (P value 0.5).\u003c/p\u003e\n\u003cp\u003e(D) All patients in both groups had a one-day post-operative hospital stay.\u003c/p\u003e\n\u003cp\u003e(E) The mean operative time in the Levatorplasty group was 58.0 \u0026plusmn; 12.29 minutes, while in the Without Levatorplasty group, it was 52.3 \u0026plusmn; 5.1 minutes. There was no statistically significant difference in operative times between these two groups (P value 0.19).\u003c/p\u003e\n\u003cp\u003eThese findings provide insights into the outcomes and characteristics associated with the Ventral Mesh Rectopexy procedure in both groups, highlighting the absence of statistically significant differences in Dyspareunia, postoperative pain, recurrence rates, and operative times.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.11340206185567%\" colspan=\"2\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eRectopexy operation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.52577319587629%\" valign=\"top\"\u003e\n \u003cp\u003eWith Levatorplasty\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.52577319587629%\" valign=\"top\"\u003e\n \u003cp\u003eWithout Levatorplasty\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.402061855670103%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eTest value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.154639175257732%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eSig.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003eNo. = 10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003eNo. = 10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.711340206185568%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eDyspareunia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.402061855670103%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.52577319587629%\" valign=\"top\"\u003e\n \u003cp\u003e8 (80.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.52577319587629%\" valign=\"top\"\u003e\n \u003cp\u003e9 (90.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.402061855670103%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.392*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.531\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.154639175257732%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.659574468085108%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.170212765957444%\" valign=\"top\"\u003e\n \u003cp\u003e2 (20.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.170212765957444%\" valign=\"top\"\u003e\n \u003cp\u003e1 (10.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.711340206185568%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003ePost-operative pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.402061855670103%\" valign=\"top\"\u003e\n \u003cp\u003eMean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.52577319587629%\" valign=\"top\"\u003e\n \u003cp\u003e4.2 \u0026plusmn; 1.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.52577319587629%\" valign=\"top\"\u003e\n \u003cp\u003e4.3 \u0026plusmn; 1.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.402061855670103%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e-0.147\u0026bull;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.885\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.154639175257732%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.659574468085108%\" valign=\"top\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.170212765957444%\" valign=\"top\"\u003e\n \u003cp\u003e2 \u0026ndash; 7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.170212765957444%\" valign=\"top\"\u003e\n \u003cp\u003e2 \u0026ndash; 7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.711340206185568%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eRecurrence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.402061855670103%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.52577319587629%\" valign=\"top\"\u003e\n \u003cp\u003e9 (90.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.52577319587629%\" valign=\"top\"\u003e\n \u003cp\u003e8 (80.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.402061855670103%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.392*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.531\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.154639175257732%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.659574468085108%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.170212765957444%\" valign=\"top\"\u003e\n \u003cp\u003e1 (10.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.170212765957444%\" valign=\"top\"\u003e\n \u003cp\u003e2 (20.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.711340206185568%\" valign=\"top\"\u003e\n \u003cp\u003eHospital Stay\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.402061855670103%\" valign=\"top\"\u003e\n \u003cp\u003e1 Day\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.52577319587629%\" valign=\"top\"\u003e\n \u003cp\u003e10 (100.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.52577319587629%\" valign=\"top\"\u003e\n \u003cp\u003e10 (100.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.402061855670103%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.154639175257732%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.711340206185568%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eOperative time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.402061855670103%\" valign=\"top\"\u003e\n \u003cp\u003eMean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.52577319587629%\" valign=\"top\"\u003e\n \u003cp\u003e58 \u0026plusmn; 12.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.52577319587629%\" valign=\"top\"\u003e\n \u003cp\u003e52.3 \u0026plusmn; 5.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.402061855670103%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e1.354\u0026bull;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.154639175257732%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.659574468085108%\" valign=\"top\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.170212765957444%\" valign=\"top\"\u003e\n \u003cp\u003e45 \u0026ndash; 90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.170212765957444%\" valign=\"top\"\u003e\n \u003cp\u003e45 \u0026ndash; 60\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable (17): Comparison between With Levatorplasty and Without Levatorplasty regarding postoperative data in Rectopexy operation.\u003c/p\u003e\n\u003cp\u003eTable shows Postoperative, median Wexner score in Without Levatorplasty (3) was less that in Levatorplasty group (0) so Wexner score reduction in Levatorplasty group is more than in Without Levatorplasty but with no statistically significant difference (P value 0.27).\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.458333333333336%\" colspan=\"2\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eRectopexy operation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.916666666666668%\" valign=\"top\"\u003e\n \u003cp\u003eWith Levatorplasty\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.916666666666668%\" valign=\"top\"\u003e\n \u003cp\u003eWithout Levatorplasty\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.291666666666667%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eTest value\u0026Dagger;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.25%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.166666666666667%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eSig.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003eNo. = 10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003eNo. = 10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.666666666666668%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eWexner Pre\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\" valign=\"top\"\u003e\n \u003cp\u003eMedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.916666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e16 (14 - 18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.916666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e16 (8 - 17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.291666666666667%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e-0.499\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.25%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.618\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.166666666666667%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.158730158730158%\" valign=\"top\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"34.92063492063492%\" valign=\"top\"\u003e\n \u003cp\u003e8 \u0026ndash; 20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"34.92063492063492%\" valign=\"top\"\u003e\n \u003cp\u003e3 \u0026ndash; 20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.666666666666668%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eWexner Post\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\" valign=\"top\"\u003e\n \u003cp\u003eMedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.916666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e0 (0 - 3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.916666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e3 (0 - 8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.291666666666667%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e-1.096\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.25%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.273\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.166666666666667%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.158730158730158%\" valign=\"top\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"34.92063492063492%\" valign=\"top\"\u003e\n \u003cp\u003e0 \u0026ndash; 16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"34.92063492063492%\" valign=\"top\"\u003e\n \u003cp\u003e0 \u0026ndash; 19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.458333333333336%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eWillcoxon Rank test\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.916666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e-2.673\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.916666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e-2.375\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.291666666666667%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.25%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.166666666666667%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.30379746835443%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.848101265822784%\" valign=\"top\"\u003e\n \u003cp\u003e0.008 (HS)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.848101265822784%\" valign=\"top\"\u003e\n \u003cp\u003e0.018 (S)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable (18): Comparison between With Levatorplasty and Without Levatorplasty regarding Wexner score pre-operative and post-operative in Rectopexy operation.\u003c/p\u003e\n\u003cp\u003eSTARR Operation:\u003c/p\u003e\n\u003cp\u003eTen patients from each group underwent the STARR procedure. Here are the findings:\u003c/p\u003e\n\u003cp\u003e(F) Dyspareunia was reported in 2 patients in the Levatorplasty group, while 1 patient reported Dyspareunia in the Without Levatorplasty group. However, there was no statistically significant difference in the occurrence of Dyspareunia between these two groups (P value 0.5).\u003c/p\u003e\n\u003cp\u003e(G) The mean postoperative pain score was 4.6 \u0026plusmn; 1.17 in the Levatorplasty group and 4.1 \u0026plusmn; 0.88 in the Without Levatorplasty group. There was no statistically significant difference in postoperative pain scores between these two groups (P value 0.295).\u003c/p\u003e\n\u003cp\u003e(H) In terms of recurrence, there were no cases of recurrence in the Levatorplasty group, while 2 patients in the Without Levatorplasty group experienced recurrence. The difference in recurrence rates between the two groups was not statistically significant (P value 0.136).\u003c/p\u003e\n\u003cp\u003e(I) All patients in both groups had a one-day post-operative hospital stay.\u003c/p\u003e\n\u003cp\u003e(J) The mean operative time in the Levatorplasty group was 50.5 \u0026plusmn; 5.1 minutes, while in the Without Levatorplasty group, it was 47.7 \u0026plusmn; 1.64 minutes. However, there was no statistically significant difference in operative times between these two groups (P value 0.1).\u003c/p\u003e\n\u003cp\u003eThese findings provide insights into the outcomes and characteristics associated with the STARR procedure in both groups, emphasizing the absence of statistically significant differences in Dyspareunia, postoperative pain, recurrence rates, and operative times.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.541666666666664%\" colspan=\"2\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eSTARR operation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.708333333333332%\" valign=\"top\"\u003e\n \u003cp\u003eWith Levatorplasty\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.708333333333332%\" valign=\"top\"\u003e\n \u003cp\u003eWithout Levatorplasty\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eTest value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.166666666666667%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eSig.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003eNo. = 10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003eNo. = 10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.157894736842106%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eDyspareunia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.736842105263158%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.894736842105264%\" valign=\"top\"\u003e\n \u003cp\u003e8 (80.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.894736842105264%\" valign=\"top\"\u003e\n \u003cp\u003e9 (90.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.631578947368421%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.392*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.531\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.2105263157894735%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.166666666666668%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.416666666666664%\" valign=\"top\"\u003e\n \u003cp\u003e2 (20.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.416666666666664%\" valign=\"top\"\u003e\n \u003cp\u003e1 (10.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.157894736842106%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003ePost-operative pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.736842105263158%\" valign=\"top\"\u003e\n \u003cp\u003eMean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.894736842105264%\" valign=\"top\"\u003e\n \u003cp\u003e4.6 \u0026plusmn; 1.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.894736842105264%\" valign=\"top\"\u003e\n \u003cp\u003e4.1 \u0026plusmn; 0.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.631578947368421%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e1.080\u0026bull;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.295\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.2105263157894735%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.166666666666668%\" valign=\"top\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.416666666666664%\" valign=\"top\"\u003e\n \u003cp\u003e3 \u0026ndash; 7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.416666666666664%\" valign=\"top\"\u003e\n \u003cp\u003e3 \u0026ndash; 6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.157894736842106%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eRecurrence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.736842105263158%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.894736842105264%\" valign=\"top\"\u003e\n \u003cp\u003e10 (100.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.894736842105264%\" valign=\"top\"\u003e\n \u003cp\u003e8 (80.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.631578947368421%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e2.222*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.136\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.2105263157894735%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.166666666666668%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.416666666666664%\" valign=\"top\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.416666666666664%\" valign=\"top\"\u003e\n \u003cp\u003e2 (20.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.157894736842106%\" valign=\"top\"\u003e\n \u003cp\u003eHospital Stay\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.736842105263158%\" valign=\"top\"\u003e\n \u003cp\u003e1 Day\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.894736842105264%\" valign=\"top\"\u003e\n \u003cp\u003e10 (100.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.894736842105264%\" valign=\"top\"\u003e\n \u003cp\u003e10 (100.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.631578947368421%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.2105263157894735%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.157894736842106%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eOperative time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.736842105263158%\" valign=\"top\"\u003e\n \u003cp\u003eMean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.894736842105264%\" valign=\"top\"\u003e\n \u003cp\u003e50.5 \u0026plusmn; 5.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.894736842105264%\" valign=\"top\"\u003e\n \u003cp\u003e47.7 \u0026plusmn; 1.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.631578947368421%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e1.652\u0026bull;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.116\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.2105263157894735%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.166666666666668%\" valign=\"top\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.416666666666664%\" valign=\"top\"\u003e\n \u003cp\u003e47 \u0026ndash; 60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.416666666666664%\" valign=\"top\"\u003e\n \u003cp\u003e45 \u0026ndash; 50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable (19): \u0026nbsp;Comparison between With Levatorplasty and Without Levatorplasty regarding postoperative data in STARR operation.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable shows Postoperative, median Wexner score in Without Levatorplasty (0.5) was less that in Levatorplasty group (0) so Wexner score reduction in Levatorplasty group is more than in Without Levatorplasty but with no statistically significant difference (P value 0.3).\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.02061855670103%\" colspan=\"2\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eSTARR operation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003eWith Levatorplasty\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003eWithout Levatorplasty\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.43298969072165%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eTest value\u0026Dagger;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.154639175257732%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eSig.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003eNo. = 10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003eNo. = 10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.49484536082474%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eWexner Pre\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.52577319587629%\" valign=\"top\"\u003e\n \u003cp\u003eMedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e13 (10 - 17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e15 (10 - 17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.43298969072165%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e-0.266\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.790\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.154639175257732%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.075471698113205%\" valign=\"top\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.9622641509434%\" valign=\"top\"\u003e\n \u003cp\u003e8 \u0026ndash; 20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.9622641509434%\" valign=\"top\"\u003e\n \u003cp\u003e8 \u0026ndash; 20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.49484536082474%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eWexner Post\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.52577319587629%\" valign=\"top\"\u003e\n \u003cp\u003eMedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e0 (0 - 1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e0.5 (0 - 1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.43298969072165%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.991\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.322\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.154639175257732%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.075471698113205%\" valign=\"top\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.9622641509434%\" valign=\"top\"\u003e\n \u003cp\u003e0 \u0026ndash; 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.9622641509434%\" valign=\"top\"\u003e\n \u003cp\u003e0 \u0026ndash; 10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.02061855670103%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eWillcoxon Rank test\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e-2.805\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e-2.805\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.43298969072165%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.154639175257732%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.82608695652174%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.08695652173913%\" valign=\"top\"\u003e\n \u003cp\u003e0.005 (HS)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.08695652173913%\" valign=\"top\"\u003e\n \u003cp\u003e0.005 (HS)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable (20): Comparison between With Levatorplasty and Without Levatorplasty regarding Wexner score pre-operative and post-operative in STARR operation\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eComplete rectal prolapse (CPR) is defined as the complete protrusion of all layers of the rectum through the anus. The pathogenesis of CPR is a subject of controversy, but the most validated hypothesis suggests an association between the weakness of connective tissue attachments of the rectal mucosa and the development of an internal rectal prolapse, which progresses to a full-thickness external prolapse under straining. Other risk factors include multiparity, traumatic perineal injury, obesity or anorexia in young patients, as well as psychiatric and connective tissue diseases (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Rectal prolapse (RP) is a debilitating condition that can cause symptoms such as fecal incontinence, obstructed defecation, incomplete evacuation of the rectum, rectal pressure, and pain. While conservative treatment options, including behavior modification and biofeedback of the pelvic floor, may alleviate symptoms, surgical management remains the only curative option, with the goal of improving bowel function and quality of life (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn recent years, surgeons have increasingly offered concomitant combined surgical repair as part of a multidisciplinary evaluation and treatment approach (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). A study by the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) has recently demonstrated an increase in combined RP and POP surgeries from 2.6\u0026ndash;7% over the past decade (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). The primary aim of treatment is to eliminate the prolapse, correct associated functional abnormalities such as incontinence or constipation, and prevent de novo bowel dysfunction. This goal can be achieved through rectal fixation to the sacrum and/or resection or plication of redundant bowel tissue. The approach may be transanal/perineal or transabdominal (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn recent years, there has been growing evidence suggesting that prolapse development is strongly associated with the size of the pelvic hiatus (GH) (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Multiple surgical studies have indicated that an enlarged pelvic hiatus may increase the risk of prolapse recurrence (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). The levator ani muscles play a crucial role in pelvic organ support, with the main components being the iliococcygeus and puborectalis muscles. A third muscle, the pubococcygeus, is situated between the iliococcygeus and puborectalis muscles. A flat region can be observed between the anus and coccyx, where the levator ani muscles converge in the midline (iliococcygeal raphe), corresponding to the levator plate (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe iliococcygeus muscle is a thin, sagittally oriented, fan-shaped structure that assumes a curved shape with inferior concavity when viewed in the coronal plane. It has lateral insertions into the pelvic sidewalls. Posteriorly, it forms a raphe that blends with the attachment of the external anal sphincter to create the anococcygeal ligament, a fascial condensation formerly known as the levator plate, which inserts onto the coccyx. The puborectalis muscle is a U-shaped sling that inserts on the inner pubis as it encircles the anorectal junction. The levator plate angle plays a critical role in normal support, with the normal angle being 4.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7. Accordingly, pelvic organ prolapse is primarily related to levator ani defects, and associated fascial defects further increase the risk of pelvic floor dysfunction (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOur study is a prospective cohort study aimed at investigating the role of levatorplasty in the management of rectal prolapse in patients with a wide pelvic hiatus. All patients underwent rectal prolapse surgery, including ALTEMEIER'S, STARR, Ventral Mesh Rectopexy, or POPS, as a primary one-stage procedure using the same surgical technique over a 20-month period at El Kasr Alaini teaching hospital from July 2021 to February 2023. Thirty patients underwent rectal prolapse repair without levatorplasty, while 30 patients underwent rectal prolapse repair with levatorplasty.\u003c/p\u003e \u003cp\u003eIn a study by Chun et al. (2003), a total of 109 consecutive patients (10 men) underwent 120 perineal procedures. These patients were retrospectively evaluated in two groups based on the type of surgery they received: perineal rectosigmoidectomy (PRS) or perineal rectosigmoidectomy with levatorplasty (PRSL). Both groups showed significant improvements in postoperative incontinence scores (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001) (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Similarly, in our study, all patients showed a decrease in Wexner scores over time (pre-operative and post-operative) with a statistically significant difference (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eRegarding recurrence rates and mean time interval to recurrence in Chun et al.'s study, they were 20.6% and 45.5 months in PRS compared to 7.7% and 13.3 months in PRSL (p\u0026thinsp;=\u0026thinsp;0.049) (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). In our study, postoperative recurrence in the Levatorplasty group was 1 (3.3%), which was lower than the recurrence rate in the Without Levatorplasty group, which was 6 (20%) with a statistically significant difference (p\u0026thinsp;=\u0026thinsp;0.044).\u003c/p\u003e \u003cp\u003eIn their study, Chun et al. reported a mean duration of surgery of 78.1 minutes (SD\u0026thinsp;=\u0026thinsp;25.9) in PRS and 97.6 minutes (SD\u0026thinsp;=\u0026thinsp;32.3) in PRSL (p\u0026thinsp;=\u0026thinsp;0.002) (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). However, in our study, the mean operative time in the levatorplasty group was 47.33\u0026thinsp;\u0026plusmn;\u0026thinsp;13.00 minutes, while in the without levatorplasty group, it was 40.77\u0026thinsp;\u0026plusmn;\u0026thinsp;13.90 minutes, with no statistically significant difference (p\u0026thinsp;=\u0026thinsp;0.433).\u003c/p\u003e \u003cp\u003eRegarding postoperative hospital stay, there was no significant difference between the two groups in Chun et al.'s study (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Similarly, in our study, there was no statistically significant difference, as all patients had a one-day hospital stay.\u003c/p\u003e \u003cp\u003eIn another study by Mohamed et al. (2013), 82 consecutive patients with rectal prolapse were randomized. Participants were randomly allocated to receive Delorme operation only (Group I) or Delorme operation with postanal repair and levatorplasty (Group II). They reported an improvement in continence mechanism in both groups postoperatively, with higher improvement in Group II (p value\u0026thinsp;=\u0026thinsp;0.004) (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Similarly to our study, there was a decrease in Wexner scores over time (pre-operative and post-operative) with a statistically significant difference (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Regarding recurrence rates in Mohamed et al.'s study, the recurrence rate after one year was 14.28% in Group I and 2.43% in Group II (P\u0026thinsp;=\u0026thinsp;0.043) (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). In our study, postoperative recurrence in the Levatorplasty group was 1 (3.3%), which was less than that in the Without Levatorplasty group, where it was 6 (20%), with a statistically significant difference (P value 0.044). In their study, Mohamed et al. also reported a significant difference in operative time between the two groups, with longer operative time in Group II (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). However, in our study, the mean operative time showed no statistically significant difference between both groups.\u003c/p\u003e \u003cp\u003eIn K\u0026ouml;hler et al.'s study (2001), patients with disabling anorectal incontinence had a posterior levatorplasty performed concomitantly during operative removal of the prolapse. They reported a significant decrease in the incontinence score in the group with levatorplasty (preoperative 16.4\u0026thinsp;\u0026plusmn;\u0026thinsp;3.1, postoperative 9.3\u0026thinsp;\u0026plusmn;\u0026thinsp;4.5, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), compared to the other group with preoperative 15.6\u0026thinsp;\u0026plusmn;\u0026thinsp;4.2, postoperative 11.5\u0026thinsp;\u0026plusmn;\u0026thinsp;5.1 (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). As in our study, there was a decrease in Wexner scores over time (pre-operative and post-operative) with a statistically significant difference (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In another study by El-Sibai et al. (2002), the study included 28 patients presenting with Complete Rectal Prolapse. Fourteen patients had fecal incontinence. Posterior levatorplasty was performed in 14 adult patients who were incontinent due to a wide levator hiatus. Regarding the incontinence score, there was a significant improvement in the Wexner score, as all 14 incontinent patients became continent after the operation. The tendency to strain at defecation gradually disappeared in the first 3\u0026ndash;4 postoperative weeks, resulting in normal defecation (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Similarly, in our study, there was a decrease in Wexner scores over time (pre-operative and post-operative) with a statistically significant difference (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eRegarding recurrence rate in El-Sibai et al.'s study, 1 patient had CRP 3 months after the operation (this patient used to defecate in the squatting position) (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). In our study, postoperative recurrence in the Levatorplasty group was 1 (3.3%), which was lower than that in the Without Levatorplasty group, where it was 6 (20%), with a statistically significant difference (P value 0.044). In another study by Bananzadeh et al. (2021), medical records of patients who underwent the Altemeier procedure at Shahid Faghihi Hospital (in Shiraz, Iran) from 2014 to 2018 were retrospectively studied. Patients older than 17 years of age who underwent the Altemeier procedure due to complete rectal prolapse were considered. In some cases, the operation was performed with posterior levatorplasty. In total, 53 patients (17 men and 36 women) with a mean age of 55.23\u0026thinsp;\u0026plusmn;\u0026thinsp;18.24 years were analyzed (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eRegarding Wexner scores, the comparison of the pre- and postoperative scores on the Wexner scale between the two groups revealed no statistically significant difference (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). However, in our study, there was a decrease in Wexner scores over time (pre-operative and post-operative) with a statistically significant difference (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, rectal prolapse (RP) is a debilitating condition that manifests with distressing symptoms, including fecal incontinence, obstructed defecation, incomplete rectal evacuation, and rectal pressure and pain. Our comprehensive analysis of this condition has shed light on significant factors influencing its pathogenesis and surgical management.\u003c/p\u003e \u003cp\u003eOne crucial factor in the development of RP is the size of the pelvic hiatus (GH), with a normal range of 4.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7. Our research has affirmed the strong association between GH size and the likelihood of prolapse occurrence. Multiple surgical studies have concurred on the notion that an enlarged pelvic hiatus is a contributing factor to prolapse recurrence.\u003c/p\u003e \u003cp\u003eOur study took a multifaceted approach to address the challenges of RP management. Specifically, we focused on rectal prolapse repair combined with levatorplasty in patients presenting with rectal prolapse and wide pelvic hiatus. The results of our investigation have demonstrated that this combined approach yields superior outcomes in terms of Wexner score improvement and recurrence rate reduction.\u003c/p\u003e \u003cp\u003eThese findings underscore the significance of a multidisciplinary approach to rectal prolapse management, where both anatomical factors like GH size and surgical techniques such as levatorplasty play pivotal roles. By integrating these insights into clinical practice, we can better tailor treatments for patients with RP, ultimately enhancing their quality of life and minimizing the risk of recurrence. Our research contributes to the growing body of knowledge in this field and paves the way for more effective and personalized management strategies for individuals suffering from rectal prolapse.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cdiv\u003e\n \u003cp\u003e\u003cstrong\u003eCompliance with ethical standards\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eThis article does not contain any studies with human or animal subjects performed by any of the authors.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eNo sources of funding were used to assist in the preparation of this review.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eConflicts of interest \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eThe authors declare that there is no conflict of interest.\u0026nbsp;\u003c/p\u003e\n\u003c/div\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eRao SSC, Tetangco EP. 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PMID: 23187047.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eK\u0026ouml;hler A, Athanasiadis S. The value of posterior levator repair in the treatment of anorectal incontinence due to rectal prolapse\u0026ndash;a clinical and manometric study. Langenbecks Arch Surg. 2001;386(3):188 \u0026ndash; 92. doi: 10.1007/s004230100223. PMID: 11382320.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShafik A, El-Sibai O, Shafik AA. Physiological assessment of the function of the ileocecal junction with evidence of ileocecal junction reflexes. Med Sci Monit. 2002;8(9):CR629-35. PMID: 12218944.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBananzadeh A, Razavi HS, Khodaei S, Al-Qanbar MH, Tadayon SMK, Hosseini SV, et al. Outcome of Fecal Incontinence in Patients with Rectal Prolapse Undergoing the Altemeier Procedure with or without Posterior Levatorplasty. Journal of Coloproctology. 2021; CC BY-NC-ND 4.0 \u0026middot; Journal of Coloproctology 2021; 41(01): 052\u0026ndash;057; DOI: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1055/s-0041-1724063\u003c/span\u003e\u003cspan address=\"10.1055/s-0041-1724063\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Cairo University hospitals","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Levatorplasty, Rectal prolapse, Wide pelvic hiatus, MRI defecography, coloproctology, colorectal surgery","lastPublishedDoi":"10.21203/rs.3.rs-3342754/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3342754/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eRectal prolapse (RP) is a debilitating condition associated with symptoms such as fecal incontinence, obstructed defecation, incomplete rectal evacuation, and significant discomfort. Recent evidence highlights the strong correlation between prolapse development and the size of the pelvic hiatus (GH). Surgical studies have suggested a potential link between an enlarged pelvic hiatus and prolapse recurrence. This study aims to evaluate recurrence rates in patients with rectal prolapse characterized by a wide pelvic hiatus who underwent surgical management.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eIn this prospective cohort study, 60 patients with rectal prolapse and a wide pelvic hiatus were divided into two groups, each comprising 30 patients. One group underwent rectal prolapse repair, while the other group underwent rectal prolapse repair with levatorplasty.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe levatorplasty group exhibited notable improvements in Wexner scores and lower recurrence rates compared to the other group. Both groups demonstrated similar outcomes in terms of postoperative pain and dyspareunia.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eRectal prolapse repair combined with levatorplasty represents an effective approach for patients presenting with rectal prolapse and a wide pelvic hiatus. This combination results in improved Wexner scores and reduced recurrence rates, providing valuable insights into the management of this challenging condition.\u003c/p\u003e","manuscriptTitle":"Role of Levatorplasty in Management of Rectal Prolapse in Patients with Wide Pelvic Hiatus","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-09-12 15:26:08","doi":"10.21203/rs.3.rs-3342754/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"cc68dd73-a387-4ddf-952b-90bad90bb09e","owner":[],"postedDate":"September 12th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":24526068,"name":"Surgery"},{"id":24526069,"name":"General Surgery"}],"tags":[],"updatedAt":"2023-09-15T00:14:20+00:00","versionOfRecord":[],"versionCreatedAt":"2023-09-12 15:26:08","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3342754","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3342754","identity":"rs-3342754","version":["v1"]},"buildId":"omnImTCwR2MFx8CMYfrG7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}