GS11P LAPAROSCOPIC ANTERIOR RECTOPEXY: CURES RECTAL PROLAPSE AND IMPROVES PREOP CONSTIPATION WITHOUT INDUCING NEW‐ONSET CONSTIPATION

Abstract

Purpose Abdominal posterior rectopexy for rectal prolapse produces the lowest recurrence rates. However, 50% are troubled by severe postoperative constipation. Resection mitigates this dysfunction but involves the risks of an anastomosis. We aimed to evaluate functional results with laparoscopic anterior rectopexy, a novel technique designed to avoid rectal denervation and constipation.Methodology Between January 2004 and December 2006 consecutive patients with rectal prolapse were offered undergoing laparoscopic anterior rectopexy. Patients were assessed preoperatively, at 3 and 12 months clinically and functionally (Wexner constipation and Faecal Incontinence Severity Index scores).Results 63 consecutive patients underwent laparoscopic anterior rectopexy. In this period no patient underwent a perineal procedure. Follow‐up was for a median of 18 months (range 3–36 months). Minor complications occurred in 11%. There was one recurrence (2%), one conversion and no 30‐day mortality. Median operating time (144 mins) and length of stay (3 days) shortened with experience. Constipation improved in 78% and median constipation scores fell from 8 to 3 (p < 0.0001). In no patients was severe new‐onset constipation induced. Continence improved in 90% and median incontinence scores fell from 32 to 0 (p < 0.0001).Conclusion Laparoscopic anterior rectopexy cures rectal prolapse and corrects incontinence equivalent to a posterior rectopexy. However uniquely it improves associated constipation without inducing new severe constipation, with the morbidity profile of a minimally invasive procedure. These qualities enable it to become the new gold standard for rectal prolapse.