Abstract
PurposeThe choice of surgical procedure for rectal prolapse (RP) is challenging because of the high recurrence and morbidity rates. We aimed to clarify whether laparoscopic suture rectopexy (lap-rectopexy) is suitable for Japanese patients with recurrent RP.MethodsWe retrospectively evaluated 77 recurrent RP patients who had been treated on average 1.5 times between June 2008 and April 2016. Forty-one patients underwent lap-rectopexy and 36 underwent perineal procedures. We compared surgical outcomes and recurrence rate following surgery between the two groups. The multivariable logistic regression analysis was performed to determine risk factors of recurrent RP.ResultsIn patients’ characteristics, significant differences were observed in the type of anesthesia (p < 0.01) and length of recurrent RP (p = 0.030). The mean operative time was significantly longer in the lap-rectopexy group (p < 0.001). Blood loss, length of hospitalization, and postoperative complications were similar. The recurrence rate was significantly lower in the lap-rectopexy group (17.1% vs. 38.9%, p = 0.032). Multivariate analysis showed that only the laparoscopic approach was significantly associated with a low recurrence following surgery (odds ratio 0.273, 95% CI − 2.568 to − 0.032).ConclusionLap-rectopexy is recommended for recurrent RP because its low recurrence rate and safety profile are similar to those of perineal procedures.
Highlights
Rectal prolapse (RP) is a well-known, troublesome disease that develops mainly in older women. It is associated with significant morbidity, which may include rectal bleeding, obstructive defecation, and pain, resulting in reduced quality of life (QOL) of elderly patients with RP
It is generally accepted that an abdominal procedure for RP has a lower recurrence rate and improved functional outcomes [1]
The median length of recurrent RP in the lap-rectopexy group was 50 mm, which was significantly shorter than 60 mm (17–115 mm) in the perineal group (p = 0.030)
Summary
Rectal prolapse (RP) is a well-known, troublesome disease that develops mainly in older women It is associated with significant morbidity, which may include rectal bleeding, obstructive defecation, and pain, resulting in reduced quality of life (QOL) of elderly patients with RP. Perineal procedures—as typified by the Altemeier and Delorme procedures—have been performed widely because of its lower operative morbidity rate and good recovery after surgery for frail elderly patients with comorbidities [2]. Multiple recurrences following surgical repair for RP is a critical problem in RP surgery. It can be challenging to decide the subsequent repair treatment that would be appropriate for patients with multiple recurrent RP following surgery. Laparoscopic techniques have been added as treatment options for RP because of their advantages of early recovery, less pain, and the possibility of lower morbidity. Some researchers have reported that laparoscopic procedures represent a new surgical approach as an alternative to conventional abdominal procedures [3,4,5,6,7,8]
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