Posterior sagittal approach for mesh rectopexy as a management of complete rectal in adults

Abstract

Objectives: The aim of this study was to evaluate prospectively the functional outcome of posterior sagittal rectopexy with prolene mesh for rectal prolapse in young adults.

Patients and methods: The study was carried out on 32 patients, 21 were males (65.63%) presented with complete rectal prolapse with a mean age of 36.7 +/- (range, 28-45) years. All patients were subjected to preoperative colonoscopy, clinical assessment, and anorectal manometry, dynamic magnetic resonance defecography before and after posterior sagittal rectopexy with prolene mesh. Anal incontinence and constipation were evaluated using a Wexner scale and Cleveland clinic constipation score, respectively. The patients were followed for a mean of 18.7 +/- 6.4 months.

Results: Fecal incontinence score recovered from 11.1 +/- 4.3 to 4.38 +/- 6.7, and constipation was improved in 13 out of 15 cases (86.57%). Straining anorectal angle (S-ARA) by MRI defecography improved from 127.2 +/- 5.9 degrees of 93.5 +/- 4.5 degrees (P < 0.05), perineal descent (PD) improved from 15.9 +/- 3.1 cm to 7.3 +/- 1.5 cm (P < 0.05). Maximal resting pressure (MRP) increased from 19.8 +/- 4.7 cm H(2)O to 43.5 +/- 3.9 cm H(2)O (P < 0.05). No mortality occurred, single case of recurrence of prolapse (3.22%), mucosal prolapse in two patients (6.44%), and mild wound infection in three patients (9.38%).

Conclusion: These findings indicate that posterior sagittal rectopexy with prolene mesh in adults with rectal prolapse is an effective technique, with excellent functional results and without major morbidities, but still long-term results are awaited.