Laparoscopic posterior rectopexy for complete rectal prolapse: Is it the ideal procedure for males?

Abstract

Background: Rectal prolapse is more common in elderly women worldwide, but in India, it predominantly occurs in young- and middle-aged males. While ventral mesh rectopexy is proposed as the preferred procedure in females, the debate on the best procedure in men is still wide open.

Methods: A retrospective review of all adult male patients operated for external rectal prolapse (ERP) between January 2005 and December 2019 was performed. Patients either underwent modified laparoscopic posterior mesh rectopexy (LPMR) or laparoscopic resection rectopexy (LRR). The outcome was analysed in terms of recurrence, post-operative constipation, sexual dysfunction and other complications.

Results: A total of 118 male patients were included (LPMR: 106, LRR: 12). The mean age was 46.2 years (standard deviation [SD] 11.8, range: 21-88). The mean operating time was 108 min (SD: 24). The mean length of hospital stay was 4.8 days (SD: 1.4, range: 3-11 days). There was no anastomotic leak in the LRR group. Other complications included wound infection (n = 2), mesh infection with sigmoid colon perforation (n = 1), constipation (n = 4), sexual dysfunction (n = 2), urinary urgency (n = 3) and retention of urine (n = 4). There was no mortality in both the groups. During a mean follow-up of 5.2 years, recurrent ERP was noted in one patient and partial mucosal prolapse was seen in three patients.

Conclusion: LPMR/LRR is a safe and effective treatment for ERP in men with very low recurrence rates. Randomised trials comparing modified LPMR with LVMR are needed to establish the better procedure in males.

Keywords: Males; posterior mesh rectopexy; rectal prolapse; rectopexy.

Figure 1

Picture showing port positions for laparoscopic posterior mesh rectopexy and laparoscopic resection rectopexy

Figure 2

Nerve preserving posterior rectal mobilisation viewed from the right side

Figure 3

Fixation of the polypropylene mesh to the sacral promontory and sacrum

Figure 4

Half wrap of the rectum done with polypropylene mesh and fixed to the rectum

Figure 5

Peritoneal suturing and extra-peritonealisation of the mesh

Figure 6

Division with linear cutting stapler at the rectosigmoid junction

Figure 7

Colorectal anastomosis after sigmoid colonic resection

Figure 8

Anchoring the mesorectum/fascia propria of the rectum to the presacral fascia overlying the sacral promontory