Laparoscopic rectopexy with Douglas pouch elevation associated with the procedure for prolapse and hemorrhoids (PPH) for complete rectal prolapse in adults

Abstract

Objective To analyze postoperative effect of a new rectopexy technique with Douglas pouch elevation for complete rectal prolapse (CRP) in adults. Methods From January 2010 to May 2011, 52 CRP cases were treated by rectopexy with Douglas pouch elevation. In terms of different surgical techniques, patients were divided into two groups: Group A (n=28) received laparoscopic rectopexy with Douglas pouch elevation; and Group B (n=24) received laparoscopic rectopexy with Douglas pouch elevation combined with procedure for prolapse and hemorrhoids (PPH). Rectal prolapse, constipation, and fecal incontinence in the two groups were assessed respectively before surgery, and on the 6th, 12th, and 24th month after surgery, postoperative complications were evaluated with severe grading of surgical complications. Results Symptoms of rectal prolapse disappeared at half a year after surgery in all patients, and relapsed to different extent afterwards. However, two years after operation, the status of rectal prolapse in Group B tended to be stable. The trend of constipation after surgery was consistent with that of rectal prolapse. In addition, fecal continence improved gradually on half a year after surgery in the two groups and recovered to the optimal status in the first postoperative year. However, in the second year, the results of fecal incontinence reduced slightly in Groups A, and Group B became stable. Two years after surgery, four cases in Groups A relapsed while there was no recurrence in Group B. Difference of Grade I to Grade Ⅲ complications among the two groups was statistically insignificant (χ2=0.05, P>0.05). Conclusions The clinical effect of laparoscopic rectopexy with Douglas pouch elevation associated with the procedure for prolapse and hemorrhoids (PPH) is better than that without PPH for female and male CRP patients with severe symptoms. Key words: Rectal prolapse; Hemorrhoids; Laparoscopy; Douglas rectopexy