Predictive Factors and Effects of Replaced Rectorectal Intussusception on Functional Outcomes in Patients with Rectoanal Intussusception Who Have Undergone Laparoscopic Ventral Rectopexy

Abstract

Rectoanal intussusception (RAI) treated using laparoscopic ventral rectopexy (LVR) may give rise to rectorectal intussusception (RRI) during defecation postoperatively. However, only a few studies have analyzed the results of LVR using pelvic floor imaging, which is important when interpreting postoperative symptoms in patients with RAI. Thus, this study was designed to find the preoperative variables that may help predict the postoperative occurrence of RRI and to determine whether RRI may have negative effects on bowel symptoms after LVR for RAI. Consecutive patients treated between 2012 and 2017 were included. Defecatory function was evaluated using the Constipation Scoring System (CSS) and the Fecal Incontinence Severity Index (FISI). Defecography was performed before and 6 months after LVR. Of the 66 patients with RAI preoperatively, 34 had mixed obstructed defecation (OD) and fecal incontinence (FI), 18 had OD alone, and 12 had FI alone. Twelve months after surgery, a reduction of at least 50% was observed in the CSS score of 25 patients (52%) with OD and in the FISI of 37 incontinent patients (87%). Postoperatively, RAI was replaced with RRI in 21 and posterior RAI in 2 patients. These anatomical changes were found in patients who had a greater anorectal angle at rest preoperatively. However, the improvement in bowel symptoms was unrelated to the anatomical changes. Improvement in bowel symptoms after LVR for RAI was unrelated to the postoperative occurrence of RRI or posterior RAI, which were found in patients who had a vertical rectum at rest preoperatively.