Laparoscopic surgery for rectal prolapse and outlet obstruction.

Abstract

The aim of this study was to assess the outcome of both laparoscopic suture rectopexy and resection-rectopexy in the treatment of complete and incomplete rectal prolapse, outlet obstruction, or both. Data from surgery were collected prospectively. Semiannual follow-up was performed by assessment of recurrence, continence, and constipation using patients' history, physical examination, continence score, and anorectal manometry. Statistical analysis was performed by chi-squared test and Student's t-test (P < 0.05 was accepted as statistically significant). Between September 1992 and February 1997, 72 patients (68 females) with a mean age of 62 (range, 23-88) years were treated laparoscopically. Indications for surgery were rectal prolapse in 21 patients, rectal prolapse combined with outlet obstruction in 36 patients, and outlet obstruction alone in 15 patients. Standard procedure was a laparoscopic suture rectopexy. A sigmoid resection was added in 40 patients. Mean duration of surgery was 227 (range, 125-360) minutes for rectopexy and 258 (range, 150-380) minutes for resection-rectopexy. Conversion was necessary in 1.4 percent (n = 1). Overall complication rate was 9.7 percent (n = 7) and mortality rate was 0 percent. Mean postoperative hospitalization was 15 (range, 6-47) days. All patients with a minimal follow-up of two years (n = 53) could be enrolled in a prospective follow-up study (mean follow-up, 30 months). No recurrence of rectal prolapse had to be recognized. Sixty-four percent of patients with incontinence before surgery were continent or had improved continence. In patients experiencing constipation preoperatively, constipation was improved or completely removed in 76 percent. No additional symptoms of constipation occurred after surgery. Laparoscopic procedures in the treatment of pelvic floor disorders, e.g., rectal prolapse or outlet obstruction, lead to acceptable functional results. However, follow-up has to be extended and long-term results of recurrence, continence, and constipation have to be evaluated.