Abstract

BackgroundThe aim of this study was to compare patients’ mid-term functional and quality of life (QoL) outcomes following robotic ventral mesh rectopexy (RVMR) and laparoscopic ventral mesh rectopexy (LVMR).MethodsThe data of consecutive female patients who underwent minimally invasive ventral mesh rectopexy for external or symptomatic internal rectal prolapse at 3 hospitals in Finland between January 2011 and December 2016 were retrospectively collected. Patients were matched by age and diagnosis at a 1:1 ratio. A disease-related symptom questionnaire was sent to all living patients at follow-up in July 2018.ResultsAfter a total of 401 patients (RVMR, n = 187; LVMR, n = 214) were matched, 152 patients in each group were included in the final analyses. The median follow-up times were 3.3 (range 1.6–7.4) years and 3.0 (range 1.6–7.6) years for the RVMR and LVMR groups, respectively. The postoperative QoL measures did not differ between the groups. Compared with the LVMR group, the RVMR group had lower postoperative Wexner Incontinence Score (median 5 vs. median 8; p < 0.001), experienced significant ongoing incontinence symptoms less often (30.6% vs. 49.0%; p < 0.001) and reported less postoperative faecal incontinence discomfort evaluated with the visual analogue scale (median 11 vs. median 39; p = 0.005). RVMR patients had a shorter hospital stay (2.2 days vs. 3.8 days; p < 0.001) but experienced more frequent de novo pelvic pain (31.8% vs. 11.8%; p < 0.001).ConclusionRVMR and LVMR patients had equal functional and QoL outcomes. Those who underwent RVMR had lower mid-term anal incontinence symptom scores but suffered more frequent de novo pelvic pain.

Highlights

  • The role of robotic surgery in treating external rectal prolapse (ERP) or symptomatic internal rectal prolapse (IRP) has not been demonstrated, and the impact on long-term outcomes remains unclear

  • After age and diagnosis matching, a total of 152 patients for both robotic ventral mesh rectopexy (RVMR) and laparoscopic ventral mesh rectopexy (LVMR) groups were included in the analyses

  • The number of patients having obstructed defecation symptoms combined with anal incontinence was higher in the RVMR group (RVMR: 18.4% vs. LVMR: 2.6%, p < 0.001)

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Summary

Introduction

The role of robotic surgery in treating external rectal prolapse (ERP) or symptomatic internal rectal prolapse (IRP) has not been demonstrated, and the impact on long-term outcomes remains unclear. A subsequent evaluation with the same study population revealed no differences in the quality of life (QoL) outcomes between the RVMR and LVMR procedures [6]. In terms of perioperative and short-term outcomes, a recent review and meta-analysis of randomised and nonrandomised studies comparing RVMR and LVMR for rectal prolapse reported that five studies with a total of 259 patients showed longer operating times and shorter hospital stays for RVMR procedures [7]. The aim of this study was to compare patients’ mid-term functional and quality of life (QoL) outcomes following robotic ventral mesh rectopexy (RVMR) and laparoscopic ventral mesh rectopexy (LVMR). Conclusion RVMR and LVMR patients had equal functional and QoL outcomes Those who underwent RVMR had lower mid-term anal incontinence symptom scores but suffered more frequent de novo pelvic pain

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