Short-term surgical and functional outcome of laparoscopic ventral mesh rectopexy for management of complete rectal prolapse

Abstract

Background There is no clear treatment of choice for the problem of complete rectal prolapse (CRP). The treatment of CRP in adults is essentially surgical. Surgical management is aimed at restoring physiology by correcting the prolapse and improving continence and constipation with acceptable mortality and recurrence rates. Objectives The aim of this study was to determine the safety and outcome of laparoscopic ventral mesh rectopexy (LVMR) for the management of patients with CRP. Patients and methods The study included 33 patients with CRP: 20 females and 13 males. Female patients were significantly obese than male patients were; however, male patients were significantly older. A total of four female patients had associated vaginal vault prolapse. All patients underwent LVMR. Surgical outcome included intraoperative, postoperative, and follow-up data. Functional outcome was assessed at 6- and 12-month postoperatively and compared versus preoperative evaluation for severity of fecal incontinence (FI) using Vaizey score, frequency, and severity of constipation using Cleveland Clinic Constipation score, and effect of FI on patient’s quality of life (QOL) using the Fecal Incontinence Quality of Life Scale score. Results All patients passed smooth uneventful operative and immediate postoperative course. No patient required conversion to laparotomy. Mean operative time was 151.9±31.6 (range: 120–240)min, and mean amount of intraoperative blood loss was 75.2±16 (range: 50–130)ml. Laparoscopic surgery provided its usual advantages concerning low postoperative pain score, and early ambulation, oral intake, and hospital discharge. Only three (9.1%) patients developed immediate postoperative complications. All patients showed significant functional improvement manifested as a significant decrease of Vaizey FI and Cleveland Clinic Constipation scores with a significant increase of Fecal Incontinence Quality of Life Scale score at 6-month postoperatively, and these scorings were progressively improved till 12-month postoperatively. Throughout the course of the 12-month postoperative follow-up, two female patients developed recurrent rectal prolapse for a frequency of 6.1%. Conclusion LVMR is a safe procedure for management of CRP within reasonable operative time and with minimal immediate postoperative morbidities. LVMR provided significant improvement of CRP-associated FI and constipation and its effect on patients’ QOL. LVMR was associated with low frequency of postoperative recurrence throughout the 12-month follow-up.