Functional Outcome After Laparoscopic Posterior Sutured Rectopexy versus Ventral Mesh Rectopexy for Rectal Prolapse: Six-Year Follow-Up of a Double-Blind, Randomised Single-Centre Study

Abstract

Background: Laparoscopic ventral mesh rectopexy (LVMR) for rectal prolapse has been widely adopted over the last decade with an intention to reduce postoperative functional bowel symptoms. The preoperative-to-postoperative change in short-term functional results in a double blinded, randomized study comparing it to laparoscopic posterior suture rectopexy (LPSR) has shown no significant difference between the two procedures after one year. The aim of the present study was to investigate the long-term functional outcomes. Methods: From November 2006-January 2014, a total of 75 patients were randomized to LVMR (n=37) or LPSR (n=38). In March 2017, questionnaires containing constipation symptom score (PAC-SYM), quality of life score (PAC-QoL), obstructed defecation score (ODS), Cleveland clinic constipation and incontinence scores (CCCS,CCIS) were mailed to all the patients included in the randomized trial to assess the long-term functional outcome. Prolapse recurrences and mesh complications were recorded. Finding: Sixty-nine patients were available for long-term follow-up. The questionnaires were completed by 64 patients (94·4%). The median followup was 6·1 years in the two groups. The total PAC-QoL was significantly lower in the LVMR group 0·26 (0·14-0·83) compared to the LPSR group 0.93 (0·32-1·61) (P=0·008). The total PAC-SYM was significantly lower in the LVMR group 0.5 (0·21-0·87) compared to the LPSR group 1.0 (0·5-1·5) (P=0·031). The ODS and the CCCS were significantly in favor of the LVMR group at six years (P=0·011 & 0·017). However, there was no difference at six years follow-up in CCIS between the two groups. Only three (8·82%) patients in the LVMR group developed recurrence compared to seven (23·33%) in the LPSR group (P=0·111). None of the patient developed mesh-related complication or re-operation. Interpretation: The long-term functional outcome after LVMR is superior to that after LPSR with a trend toward a lower recurrence rate. Larger multi-centre studies are warranted to validate these results. Previous Trial Registration: The randomized controlled study was approved by the Danish Ethical Committee (reference number M-AA-20060096) and the Danish Data Protection Agency. Informed consent was obtained from all patients according to the Declaration of Helsinki. Funding Statement: The authors stated: The study was conducted as a part of routine clinical work and no funding was received. Declaration of Interests: We declare no competing interests. Ethics Approval Statement: This long-term follow up study was classified as a quality project and a new approval from the Ethical Committee was not needed according to Danish regulations.