Outcome of laparoscopic ventral mesh rectopexy for external rectal prolapse

Abstract

Aim: The study assessed the efficacy of laparoscopic ventral mesh rectopexy (LVMR) for full thickness external rectal prolapse (ERP), including recurrent prolapse.

Method: A prospective database identified all patients undergoing LVMR for ERP over the 16-year period to December 2013. Clinical outcome, Cleveland Clinic Incontinence Score (CCIS), quality of life (QOL) and patient-reported outcome were evaluated.

Results: In total, 190 LVMRs (87% women) were performed during the study period, with a median active follow-up of 29 (1-196) months; 120 had a follow-up > 5 years and 16 > 10 years. The median time from surgery was 73 (1-196) months. The 60-day mortality, recurrence and mesh-related complication rates were 1%, 3% and 3.7%. The mean improvement in CCIS was 8 (P < 0.0001). Sixty-two patients returned a complete sequence of QOL scores (Birmingham Bowel and Urinary Symptoms Questionnaire 22), which had improved by 46% at year 1 and were sustained at a median of 4 years (P < 0.001). Mean patient-reported outcome measures for satisfaction at final review in 119 responders was 9.1/10. Thirty-nine patients underwent LVMR for recurrent ERP following perineal repair. Of these, full thickness recurrence occurred in one and there were no mesh complications. The same sustained improvement in QOL was observed.

Conclusion: LVMR for ERP is associated with low morbidity and recurrence and a long-term improvement in function and QOL. LVMR achieves the same benefits after a failed perineal procedure.

Keywords: Laparoscopic ventral mesh rectopexy; PROMs; external rectal prolapse; quality of life.