Laparoscopic ventral rectopexy for external rectal prolapse improves constipation and avoids de novo constipation
- PMID: 19486104
- DOI: 10.1111/j.1463-1318.2009.01859.x
Laparoscopic ventral rectopexy for external rectal prolapse improves constipation and avoids de novo constipation
Abstract
Objective: Abdominal rectopexy is ideal for otherwise healthy patients with rectal prolapse because of low recurrence, yet after posterior rectopexy, half of the patients complain of severe constipation. Resection mitigates this dysfunction but risks a pelvic anastomosis. The novel nerve-sparing ventral rectopexy appears to avoid postero-lateral rectal dissection denervation and thus postoperative constipation. We aimed to evaluate our functional results with laparoscopic ventral rectopexy.
Method: Consecutive rectal prolapse patients undergoing laparoscopic ventral rectopexy were prospectively assessed (Wexner Constipation and Faecal Incontinence Severity Index scores) pre-, 3 months postoperatively, and late (> 12 months).
Results: Sixty-five consecutive patients with external rectal prolapse (median age 72 years, 34% > 80 years, median follow up 19 months) underwent laparoscopic ventral rectopexy. There was one recurrence (2%) and one conversion. Morbidity (17%) and mortality (0%) were low. Median operating time was 140 min and median length of stay 2 days. At 3 months, constipation was improved in 72% and mildly induced in 2% (median pre-and postoperative Wexner scores 9 vs 4, P < 0.0001). Continence was improved in 83% and mild incontinence was induced or worsened in 5% (median pre- and postoperative incontinence score 40 vs 4, P < 0.0001). Significant improvement in both constipation and incontinence (P < 0.0001) remained at median 24 months late follow-up.
Conclusion: Ventral rectopexy has a recurrent prolapse rate of < 5%, similar to that of posterior rectopexy. Its correction of preoperative constipation and avoidance of de novo constipation appear superior to historical functional results of posterior rectopexy. A laparoscopic approach allows low morbidity and short hospital stay, even in those patients over 80 years of age in whom a perineal approach is usually preferred for safety.
Similar articles
-
Laparoscopic ventral rectopexy for internal rectal prolapse: short-term functional results.Colorectal Dis. 2010 Feb;12(2):97-104. doi: 10.1111/j.1463-1318.2009.02049.x. Epub 2009 Sep 26. Colorectal Dis. 2010. PMID: 19788493
-
Laparoscopic management of persistent complete rectal prolapse in children.J Pediatr Surg. 2010 Mar;45(3):533-9. doi: 10.1016/j.jpedsurg.2009.09.013. J Pediatr Surg. 2010. PMID: 20223316
-
Long-term functional outcomes after laparoscopic and open rectopexy for the treatment of rectal prolapse.Dis Colon Rectum. 2008 Nov;51(11):1597-604. doi: 10.1007/s10350-008-9365-6. Epub 2008 Aug 29. Dis Colon Rectum. 2008. PMID: 18758861
-
Surgical management of rectal prolapse.Arch Surg. 2005 Jan;140(1):63-73. doi: 10.1001/archsurg.140.1.63. Arch Surg. 2005. PMID: 15655208 Review.
-
Current status of laparoscopic and robotic ventral mesh rectopexy for external and internal rectal prolapse.World J Gastroenterol. 2016 Jun 7;22(21):4977-87. doi: 10.3748/wjg.v22.i21.4977. World J Gastroenterol. 2016. PMID: 27275090 Free PMC article. Review.
Cited by
-
Laparoscopic ventral mesh rectopexy for complete rectal prolapse: A retrospective study evaluating outcomes in North Indian population.World J Gastrointest Surg. 2016 Apr 27;8(4):321-5. doi: 10.4240/wjgs.v8.i4.321. World J Gastrointest Surg. 2016. PMID: 27152139 Free PMC article.
-
Mesh fistulation into the rectum after laparoscopic ventral mesh rectopexy.Int J Surg Case Rep. 2014;5(3):152-4. doi: 10.1016/j.ijscr.2013.12.012. Epub 2013 Dec 31. Int J Surg Case Rep. 2014. PMID: 24566425 Free PMC article.
-
One decade of rectal prolapse surgery: a national study.Int J Colorectal Dis. 2018 Mar;33(3):299-304. doi: 10.1007/s00384-017-2944-z. Epub 2017 Dec 23. Int J Colorectal Dis. 2018. PMID: 29273884
-
Laparoscopic ventral rectopexy: a prospective long-term evaluation of functional results and quality of life.Tech Coloproctol. 2013 Aug;17(4):431-6. doi: 10.1007/s10151-013-0973-3. Epub 2013 Jan 23. Tech Coloproctol. 2013. PMID: 23345041
-
Laparoscopic ventral rectopexy using biologic mesh for the treatment of obstructed defaecation syndrome and/or faecal incontinence in patients with internal rectal prolapse: a critical appraisal of the first 100 cases.Tech Coloproctol. 2015 Apr;19(4):209-19. doi: 10.1007/s10151-014-1255-4. Epub 2015 Jan 11. Tech Coloproctol. 2015. PMID: 25577276
MeSH terms
LinkOut - more resources
Full Text Sources
Medical