Redo ventral rectopexy: is it worthwhile?

K E Laitakari,J Kössi,M Kairaluoma,J K Mäkelä-Kaikkonen,T T Rautio,A Junttila,P Ohtonen

doi:10.1007/s10151-020-02369-5

Abstract

BackgroundMinimally invasive ventral mesh rectopexy (VMR) is a widely used surgical treatment for posterior pelvic organ prolapse; however, evidence of the utility of revisional surgery is lacking. Our aim was to assess the technical details, safety and outcomes of redo minimally invasive VMR for patients with external rectal prolapse (ERP) recurrence or relapsed symptoms of internal rectal prolapse (IRP).MethodsThis is a retrospective cohort study of patients with recurrent ERP or symptomatic IRP who underwent redo minimally invasive VMR between 2011 and 2016. The study was conducted at three hospitals in Finland. Data collected retrospectively included patient demographics, in addition to perioperative and short-term postoperative findings. At follow-up, all living patients were sent a questionnaire concerning postoperative disease-related symptoms and quality of life.ResultsA total of 43 redo minimally invasive VMR were performed during the study period. The indication for reoperation was recurrent ERP in 22 patients and relapsed symptoms of IRP in 21 patients. In most operations (62.8%), the previously used mesh was left in situ and a new one was placed. Ten (23.3%) patients experienced complications, including 2 (4.7%) mesh-related complications. The recurrence rate was 4.5% for ERP. Three patients out of 43 were reoperated on for various reasons. One patient required postoperative laparoscopic hematoma evacuation. Patients operated on for recurrent ERP seemed to benefit more from the reoperation.ConclusionsMinimally invasive redo VMR appears to be a safe and effective procedure for treating posterior pelvic floor dysfunction with acceptable recurrence and reoperation rates.

Highlights

Due to a lack of sufficient evidence, there are no broadly adopted recommendations about the use of either perineal or transabdominal techniques or what kind of procedure is the most effective for rectopexy when treating primary rectal prolapse [1]
They could not comment on other aspects of redo surgery in their consensus report, since there was, and still is, an urgent need for guidance on clinical decision-making after unsuccessful laparoscopic ventral mesh rectopexy (LVMR)
The results of the operations were divided into two groups according to anatomical diagnosis for the LVMR or robot-assisted ventral mesh rectopexy (RVMR): 22 operations (51.2%) were performed because of external rectal prolapse (ERP) and 21 operations (48.8%) for internal rectal prolapse (IRP)

Summary

Introduction

Due to a lack of sufficient evidence, there are no broadly adopted recommendations about the use of either perineal or transabdominal techniques or what kind of procedure is the most effective for rectopexy when treating primary rectal prolapse [1]. There are only two small studies that report the results of LVMR or RVMR after a primary ERP operation using a variety of surgical techniques [15, 16]. Invasive ventral mesh rectopexy (VMR) is a widely used surgical treatment for posterior pelvic organ prolapse; evidence of the utility of revisional surgery is lacking. Our aim was to assess the technical details, safety and outcomes of redo minimally invasive VMR for patients with external rectal prolapse (ERP) recurrence or relapsed symptoms of internal rectal prolapse (IRP). Methods This is a retrospective cohort study of patients with recurrent ERP or symptomatic IRP who underwent redo minimally invasive VMR between 2011 and 2016. Conclusions Minimally invasive redo VMR appears to be a safe and effective procedure for treating posterior pelvic floor dysfunction with acceptable recurrence and reoperation rates

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