Laparoscopic Suture Rectopexy Research Articles

Outcomes of Laparoscopic Suture vs Mesh Rectopexy for Complete Rectal Prolapse.

Objective To compare outcomes of laparoscopic suture and laparoscopic mesh rectopexy for the treatment of complete rectal prolapse in adults. Materials and methods This study was conducted between December 2020 to December 2022, involving 75 patients (Group A: 34; Group B: 41). Inclusion criteria encompassed confirmed complete rectal prolapse. Preoperative measures included comprehensive assessments, mechanical bowel cleansing, prophylactic antibiotics, and rectal irrigation. Surgical techniques involved laparoscopic suture rectopexy for Group A and laparoscopic mesh rectopexy for Group B. Postoperative care and follow-up evaluations were conducted. Results Group A demonstrated advantages in terms of shorter operative times, quicker bowel activity resumption, and reduced hospital stays. Intraoperative bleeding was absent in Group A, while wound-related complications were higher in Group B. Recurrence rates were lower in Group A (2.9%) compared to Group B (9.8%). Both groups exhibited improvements in incontinence grades postoperatively. Constipation increased in both groups. Conclusion Both techniques are effective in treating complete rectal prolapse, each with its advantages and considerations. Group A showed potential benefits in terms of operative efficiency and fewer complications, albeit with a potential for increased recurrence. The study emphasizes the need for individualized patient care, considering factors such as operative characteristics, postoperative outcomes, and patient preferences.

Evaluation of the Safety and Efficacy of Modified Laparoscopic Suture Rectopexy for Rectal Prolapse.

There are many surgical options for the treatment of rectal prolapse. To date, the efficacy of mesh-free laparoscopic suture rectopexy remains unclear due to the limited number of reports. This study aimed to evaluate the safety and efficacy of laparoscopic suture rectopexy. This observational cohort study is a retrospective cross-sectional analysis of a continuously maintained database. All patients underwent laparoscopic suture rectopexy for rectal prolapse between April 2012 and March 2018. The primary outcomes measured were recurrence rates and complications of laparoscopic suture rectopexy. A total of 268 patients (29 male and 239 female) underwent laparoscopic suture rectopexy. Their mean age was 77 (19-95) years, and the mean prolapse length was 6.4 (3.5-20) cm. One patient suffered an intraabdominal abscess. Spondylitis developed in another patient following surgery. The median follow-up period was 45 (12-82) months. A total of 22 patients (8.2%) developed recurrence. The average time to recurrence was 15.6 (1-44) months. Multivariate analysis revealed a significant correlation between recurrence and prolapse length >7.0 cm (OR: 1.26, 95% CI: 1.38-1.42, P < 0.01). Laparoscopic suture rectopexy for complete rectal prolapse is a minimally invasive and safe procedure that may lead to lower recurrence rates.

Assessment of Laparoscopic Posterior Mesh Rectopexy for Complete Rectal Prolapse: A Case Series with Review of Literature

Abstract Background Trans-abdominal rectopexy for complete rectal prolapse (CRP) reportedly yields more definitive results as compared with trans-perineal surgery. In the era of minimal access surgery, minimally invasive laparoscopic rectopexy has become a popular treatment option for patients with rectal prolapse (RP). Herein, we describe our preferred surgical procedure for the correction of RP and evaluate its results. We further aim to perform a comparative assessment between perioperative outcomes achieved with open and laparoscopic applications of this technique. Materials and methods This was a retrospective cross-sectional observational study conducted at a tertiary health care center in Maharashtra, India. We studied cases of RP who underwent laparoscopic posterior mesh rectopexy during the past 15 years (2005–2021), in our institution, operated upon by a single surgeon. Results Of the total 14 patients, 12 were managed with laparoscopic posterior mesh rectopexy. The remaining two underwent laparoscopic suture rectopexy. The mean operative time was 120 minutes. Constipation improved among 28.57%, remained the same among 21.42%, and worsened among 35.71% patients. No intra-operative blood transfusion was required. Mean length of hospital stay was 4 days. There were no recurrences over a mean follow-up period of 94 months, i.e., 7.83 years (range 7–197 months). Conclusions Laparoscopic posterior rectopexy can be safely performed in older patients to achieve early postoperative ambulation and significantly shorten the hospital stay. It may, therefore, be considered an effective treatment for CRP and urinary dysfunction. However, the incidence of de-novo constipation and worsening of pre-existing constipation is significantly high.

Perineal stapled prolapse resection in combination with Thiersch operation for relapsed rectal prolapse: a case report

BackgroundTreatment options for complete rectal prolapse include over 100 procedures. In previous reports, operative rectal prolapse repair, regardless of the technique by perineal approach, was associated with high recurrence rates. However, there is no consensus on the optimal surgical procedure for relapsed rectal prolapse.Case presentationA 97-year-old woman was admitted to our hospital with a chief complaint of complete rectal prolapse measuring > 5 cm. The patient had a history of laparoscopic anterior suture rectopexy without sigmoid resection under general anesthesia for complete rectal prolapse one year prior. The patient’s postoperative course was uneventful. However, her dementia worsened (Hasegawa’s dementia scale: 5/30 points) after the first operation. Further, moderate-to-severe aortic valve stenosis was first diagnosed with heart failure 6 months after the operation. Nine months after the initial surgery, she experienced a recurrence of complete rectal prolapse measuring approximately 5 cm. Considering the coexistence of advanced age, severe dementia, and aortic valve stenosis, surgery under general anesthesia was not indicated. Perineal stapled prolapse resection in combination with the t operation was planned because of its minimal invasiveness and shortened hospital stay. The procedure was performed by a team of two surgeons in the jack knife position, under spinal anesthesia.The prolapse was cut along the long-axis direction with three linear staplers and resected along the short-axis direction with four linear staplers. The cross-section of the linear stapler was reinforced with 3-0 Vicryl sutures. After rectal resection, the Thiersch operation using 1-0 nylon thread 1 cm away from the anal verge was additionally performed. The operative time was 24 min, and intraoperative blood loss was 1 mL. The postoperative course was uneventful. Three months after the operation, no recurrence was observed, and defecation function was good with improvements of Wexner score.ConclusionsPerineal stapled prolapse resection in combination with the Thiersch operation could be a useful option for patients with relapsed rectal prolapse and with poor general condition, who are not indicated for other surgical procedures.

POSTERIOR SAGITTAL ANORECTOPEXY FOR PAEDIATRIC RECTAL PROLAPSE

Introduction: Rectal prolapse is a very common and self limiting condition amongst the paediatric age group in India. Majority of the cases respond to conservative management. The various modalities of management of the same include surgical as well as medical modalities. Surgical namely Thierschs anal circlage, laparoscopic suture rectopexy, and posterior sagittal rectopexy Aim - To evaluate the safety and efcacy of posterior sagittal rectopexy in children with rectal prolapse. Patients and Methods: Twenty patients aged between 1 and 7 years presented with rectal prolapse. These patients underwent posterior sagittal anorectopexy after pre anaesthetic check up. These patients were followed up at 1week, 15days and 1month for 3 months. Results: Constipation improved in 18 out of 20 patients, who had a history of constipation before surgery. Partial mucosal prolapse recurrence occurred in two patients. Conclusion: Posterior Sagittal Rectopexy is a good option in cases of rectal prolapse in children once all the conservative methods have failed. The technique is safe and effective. It has satisfactory functional results.

What is the recommended procedure for recurrent rectal prolapse? A retrospective cohort study in a single Japanese institution

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.

Laparoscopic Management of Perineal Descent Syndrome in Pediatric Age Group

ABSTRACT Background: Perineal descent syndrome is a disease that affects the pelvic floor because of denervation of its muscles, resulting in obstructed defecation. Hints on the anatomy that may be associated with the work got, and the physiology of the anorectum was explained, discussing factors leading to continence and mechanism of defecation was presented. Objective: to diagnose the perineal descent syndrome in both cases of chronic constipation and anal incontinence and the use of laparoscopy in the management of PDS in children where the pathophysiologic changes for each case is identified and dealt with laparoscopically. Patients and Methods: This study was a prospective case study that had been conducted in pediatric surgery department, Al-Azhar university hospitals during the period from June 2019 to June 2020 after approval from the ethical review committee of Al-Azhar faculty of medicine. The study included 30 patients presented to the outpatient clinics with constipation or Fecal incontinence whom fulfilled the required Criteria. Results: In our study (n=30), 2 recurrent cases (13.3%) were found after laparoscopic suture rectopexy. Recurrence rates with mesh rectopexy or resection rectopexy was zero % and chronic conistipation and fecal incontinence are considered as a hidden cause for perineal descent syndrome. Conclusion: The anterior rectal wall has a great dynamic role in defecation thanks to its viscoelastic properties. Any rectopexy technique should never interfere or impede this vital mechanism of action. Finally chronic conistipation and fecal incontinence are considered as a hidden cause for perineal descent syndrome.

Laparoscopic Suture versus Mesh Rectopexy for the Treatment of Persistent Complete Rectal Prolapse in Children: A Comparative Randomized Study.

Purpose To compare laparoscopic mesh rectopexy with laparoscopic suture rectopexy. Patients and Methods. The prospective study was conducted at Pediatric Surgery Department, Al-Azhar University Hospitals, Cairo, Egypt between Feb 2010 and Jan 2015. Seventy-eight children with persistent complete rectal prolapse were subjected to laparoscopic rectopexy. Fourteen parents refused to participate. All patients received initial conservative treatment for more than one year. The remaining 64 patients were randomized divided into two equal groups. Group A; 32 patients underwent laparoscopic mesh rectopexy and group B, 32 underwent laparoscopic suture rectopexy. The operative time, recurrence rate, post-operative constipation, and effect on fecal incontinence, were reported and evaluated for each group. Results Sixty-four cases presented with persistent complete rectal prolapse were the material of this study. They were 40 males and 24 females. Mean age at operation was 8 (5–12) years. All cases were completed laparoscopically. Mean operative time in laparoscopic suture rectopexy was shorter than laparoscopic mesh rectopexy group. No early post-operative complications were encountered. No cases of recurrence with mesh rectopexy group while in suture rectopexy group it was 4 cases (14.2%). Post-operative constipation occurred in one case (3.57%) in suture rectopexy group and occurred in one case (3.3%) in mesh rectopexy group. Fecal incontinence improved in 26/28 cases (92.8%) in suture rectopexy while in mesh rectopexy it was improved in 30/30 cases (100%) of cases. Conclusion Both laparoscopic mesh and suture rectopexy are feasible and reliable methods for the treatment of complete rectal prolapse in children. However, no recurrence, low incidence of constipation and high improvement of incontinence at follow up more than 36 months with mesh rectopexy accordingly, we considered mesh rectopexy to be the procedure of choice in treatment of complete rectal prolapse.

Results of Laparoscopic Suture Rectopexy at Our Hospital

Results of Laparoscopic Suture Rectopexy at Our Hospital

Simplified Laparoscopic Suture Rectopexy for Idiopathic Rectal Prolapse In Children: Technique and Results

BackgroundLaparoscopic suture rectopexy is safe and effective treatment option for pediatric rectal prolapse. We performed this study to compare the outcome of modified laparoscopic suture rectopexy (MLSR) versus Classical Laparoscopic suture rectopexy (CLSR). Material and methodsThe study was conducted between June 2015 to May 2019 including all the patients with persistent rectal prolapse who underwent surgery managed by either MLSR (Group A) or CLSR (Group B). The groups were compared for constipation, operative time, blood loss, length of stay, postoperative complications. Results19 patients from MLSR and 22 patients from CLSR were evaluated. The mean operative time in MLSR group was 41.5 ± 6.2 min which was significantly lesser than CLSR group with a mean operative time of 78.6 ± 14.2 (p = 0.001). The blood loss was also less in MLSR group compared to CLSR group (p = 0.013). At three months of follow up, the constipation was less in MLSR group compared to CLSR group (p = 0.041). ConclusionThe modification makes the procedure technically easy, minimizes the chances of complications and retaining all the advantages of suture rectopexy. Level OF EvidenceLevel II.

Laparoscopic Posterolateral Suture Rectopexy for Recurrent Rectal Prolapse in Children.

Introduction: Laparoscopic rectopexy for recurrent rectal prolapse (RP) is more widely used nowadays. Strict indications are needed to get proper outcomes. The advantages rely on the careful dissection of peritoneal sac and fixation of rectum. One of the theories of recurrent RP is hernia-like physiology in front of the rectum. Purpose: The aim of this study is to present our experience of posterolateral laparoscopic suture rectopexy (LSR) in indicated children of recurrent RP. Patients and Methods: Sixteen patients were included with recurrent RP wherein all were subjected to LSR procedure after exclusion of other probable causes. Dissection of peritoneal sac anterior to the rectum was carried out followed by closure of the deep pouch by nonabsorbable sutures then fixation of the right side of rectum and sigmoid to the lateral wall of areolar tissue. Fixation to sacral promontory is done by Ethibond or Prolene sutures when redundancy is obvious. Results: The study included 11 girls and 5 boys with age ranging between 3 and 12 years in the past 5 years. Ten cases were treated earlier with injection therapy and 6 following Thiersh procedure after failure of conservative treatment for 6 months. Operative time ranged between 40 and 100 minutes. Follow-up period ranged between 6 and 36 months with mean of 19.5 months. Postoperative mucosal prolapse reported in 1 case 6 months postsurgery with no full thickness recurrence. Conclusions: LSR is an efficient technique in well-selected children of recurrent RP and could reverse this underlying pathology. Longer follow-up and evidence are needed to standardize the technique.

Functional Outcome After Laparoscopic Posterior Sutured Rectopexy versus Ventral Mesh Rectopexy for Rectal Prolapse: Six-Year Follow-Up of a Double-Blind, Randomised Single-Centre Study

Background: Laparoscopic ventral mesh rectopexy (LVMR) for rectal prolapse has been widely adopted over the last decade with an intention to reduce postoperative functional bowel symptoms. The preoperative-to-postoperative change in short-term functional results in a double blinded, randomized study comparing it to laparoscopic posterior suture rectopexy (LPSR) has shown no significant difference between the two procedures after one year. The aim of the present study was to investigate the long-term functional outcomes. Methods: From November 2006-January 2014, a total of 75 patients were randomized to LVMR (n=37) or LPSR (n=38). In March 2017, questionnaires containing constipation symptom score (PAC-SYM), quality of life score (PAC-QoL), obstructed defecation score (ODS), Cleveland clinic constipation and incontinence scores (CCCS,CCIS) were mailed to all the patients included in the randomized trial to assess the long-term functional outcome. Prolapse recurrences and mesh complications were recorded. Finding: Sixty-nine patients were available for long-term follow-up. The questionnaires were completed by 64 patients (94·4%). The median followup was 6·1 years in the two groups. The total PAC-QoL was significantly lower in the LVMR group 0·26 (0·14-0·83) compared to the LPSR group 0.93 (0·32-1·61) (P=0·008). The total PAC-SYM was significantly lower in the LVMR group 0.5 (0·21-0·87) compared to the LPSR group 1.0 (0·5-1·5) (P=0·031). The ODS and the CCCS were significantly in favor of the LVMR group at six years (P=0·011 & 0·017). However, there was no difference at six years follow-up in CCIS between the two groups. Only three (8·82%) patients in the LVMR group developed recurrence compared to seven (23·33%) in the LPSR group (P=0·111). None of the patient developed mesh-related complication or re-operation. Interpretation: The long-term functional outcome after LVMR is superior to that after LPSR with a trend toward a lower recurrence rate. Larger multi-centre studies are warranted to validate these results. Previous Trial Registration: The randomized controlled study was approved by the Danish Ethical Committee (reference number M-AA-20060096) and the Danish Data Protection Agency. Informed consent was obtained from all patients according to the Declaration of Helsinki. Funding Statement: The authors stated: The study was conducted as a part of routine clinical work and no funding was received. Declaration of Interests: We declare no competing interests. Ethics Approval Statement: This long-term follow up study was classified as a quality project and a new approval from the Ethical Committee was not needed according to Danish regulations.

Surgical options and trends in treating rectal prolapse: long-term results in a 19-year follow-up study.

Many different operations have been proposed for treating rectal prolapse, with varying recurrence rates and functional outcome. The main purpose of this study was to assess long-term results of surgery for prolapse of the rectum. We carried out a retrospective study to evaluate changing trends in surgical strategies and outcome in all patients treated in our hospital over 19years. Ninety-three patients were operated and 30 (32%) experienced recurrence of external prolapse during a median (range) follow-up time of 82 (2-231) months. There were 37 reoperations for recurrence, bringing the total number of operations to 130. From 1998 to 2010, laparoscopic posterior suture rectopexy was the preferred abdominal procedure with Delorme's operation as the perineal alternative. Observed recurrence rates were 15/49 (31%) and 8/15 (53%) during a median observation time of 84 and 9months, respectively. From 2011 to 2017, these procedures were replaced by ventral mesh rectopexy and Altemeier's rectosigmoidectomy. The observed recurrence rate for ventral mesh rectopexy was 3/22 (14%) during a median observation time of 29months. The 30-day mortality rate was 3% and complication rate 14%. The recurrence rates were high after all procedures, with no significant difference between posterior suture rectopexy and ventral mesh rectopexy, but the short observation time for the latter procedure is a limitation of the study. Both procedures had low complication rates, and ventral mesh rectopexy had no mortality.

Pediatric Rectal Prolapse.

Rectal prolapse is a common and self-limiting condition in infancy and early childhood. Most cases respond to conservative management. Patients younger than 4 years with an associated condition have a better prognosis. Patients older than 4 years require surgery more often than younger children. Multiple operative and procedural approaches to rectal prolapse exist with variable recurrence rates and without a clearly superior operation. These include sclerotherapy, Thiersch's anal cerclage, Ekehorn's rectopexy, laparoscopic suture rectopexy, and posterior sagittal rectopexy.

Outcome of a Modified Laparoscopic Suture Rectopexy for Rectal Prolapse with the Use of a Single or Double Suture: A Case Series of 15 Patients.

Case seriesPatient: —Final Diagnosis: Rectal prolapseSymptoms: Bleeding per rectum • constipationMedication: —Clinical Procedure: Simple technique for rectopexySpecialty: SurgeryObjective:Unusual setting of medical careBackground:Surgery is considered to be a mainstay of therapy for full-thickness rectal prolapse (FTRP). Surgical procedures for FTRP have been described, but optimal treatment is still controversial. The aim of this report is to evaluate the safety and feasibility of a simplified laparoscopic suture rectopexy (LSR) in a case series of 15 patients who presented with FTRP and who had postoperative follow-up for six months.Case Reports:Fifteen patients who underwent a modified LSR at our surgical unit from September 2010 were retrospectively evaluated. The mean age of the patients was 72.5±10.9 years. All 15 patients underwent general anesthesia, with rectal mobilization performed according to the plane of the total mesorectal excision. By lifting the mobilized and dissected rectum cranially to the promontorium, the optimal point for subsequent suture fixation of the rectum was marked. The seromuscular layer of the anterior right wall was then sutured to the presacral fascia using only one or two interrupted nonabsorbable polypropylene sutures. The mean operative time was 176.2±35.2 minutes, with minimal blood loss. No moderate or severe postoperative complications were observed, and there was no postoperative mortality. One patient (6.7%) developed recurrence of rectal prolapse one month following surgery.Conclusions:The advantages of this LSR procedure for the management of patients with FTRP are its simplicity, safety, efficacy, and practicality and the potential for its use in patients who can tolerate general anesthesia.

Laparoscopic Suture Rectopexy for Persistent Rectal Prolapse in Children: Is It a Safe and Effective First-Line Intervention?

Several techniques have been described for the surgical correction of rectal prolapse without any clear advantage for one technique over the other. We evaluated the use of laparoscopic suture rectopexy (LSRP) as a modality of treatment for rectal prolapse in children. Prospective data were collected for all children who presented to our center between 2011 and 2014 and required surgery for rectal prolapse. All children underwent LSRP with fixation of the mobilized rectum to the sacral promontory with multiple nonabsorbable sutures. The median follow-up period was 14 months (range, 6-29 months). The operative time, operative complications, length of hospital stay, and postoperative complications were recorded and analyzed. Seventy-four patients presented with rectal prolapse during this period. Twenty patients (27%) required LSRP. Their median age at surgery was 4.4 years (range, 2-11 years), median operative time was 77.5 minutes (range, 30-150 minutes), and the median length of hospital stay was 1 day (range, 1-4 days). Only 1 patient had full-thickness recurrence that required redo surgery, and another had mucosal prolapse, which spontaneously resolved. LSRP is a safe and effective technique for treating children with full-thickness rectal prolapse with the benefits of being minimally invasive, a short hospital stay, early recovery, and low recurrence rate.

PWE-382 Outcomes from surgery for external rectal prolapse

Introduction To compare short and medium-term outcomes of surgery for external full thickness rectal prolapse at a single university institution, where Delorme’s procedure, laparoscopic posterior suture rectopexy and laparoscopic ventral mesh rectopexy are performed. Method Patients were identified from a prospective database. Consecutive patients undergoing surgery for rectal prolapse over a five year period between 2009 and 2014 were included. Patient data including age, gender, type of operation, hospital stay, complications, readmissions, duration of follow up, recurrence and mortality were recorded. The type of surgery was selected after careful discussion with each patient including the potential risks and complications specific to each of the three surgical procedures. Cases were also discussed at a pelvic floor multidisciplinary team meeting. Results During the study period, 77 patients underwent surgery with a median age of 74 years (range 18–90). A total of 69 (89.6%) were female. There were 20 (25.9%) patients who had previously undergone surgery for prolapse. A total of 20 (26%) Delorme’s procedures, 15 (19%) laparoscopic posterior suture rectopexies and 42 (55%) laparoscopic ventral mesh rectopexies were performed. The median (range) patient age was 79 (48–90) years, 74 (30–89) years and 79 (18–88) years respectively. Median follow-up was 35 (1–120) months. Recurrence rates were 23.8%, 13.3% and 4.7% respectively. Length of hospital stay was a median (range) of 2 (1–21) days, 3 (1–7) days and 2 (1–7) days respectively. There were no mesh related complications and no 60-day mortality. Conclusion Multiple operations have been described for rectal prolapse. At our institution, laparoscopic mesh ventral rectopexy had the lowest rate of recurrence with a similar length of hospital stay when compared with the alternatives of Delorme’s procedure and laparoscopic posterior suture rectopexy. Despite this, some patients may still opt for an operation with a higher recurrence rate to avoid potential complications such as mesh erosion. Longer term data is needed to assess these risks and inform patient choice. Disclosure of interest None Declared.

PWE-380 Safety and efficacy of laparoscopic ventral mesh rectopexy and sacrocolpopexy for rectal prolapse and obstructed defecation: analysis of first 20 cases at a uk district general hospital

Introduction Laparoscopic ventral mesh rectopexy (LVMR) is gaining wider acceptance. The aim of this study is to present that LVMR can be learnt and safely performed with short term results similar to that of establish centres Method All patients presented with obstructed defecation (ODS) and rectal prolapse from January 2011 to January 2015 underwent anorectal physiology, defecation proctography, colon transit studies, colonoscopy or sigmoidoscopy as appropriate, pelvic floor MDT and biofeedback. Patients with high grade intussusception who did not respond to laxatives and biofeedback were offered LVMR. Surgical technique was as described by A. D’Hoore et al . and was performed by both authors who are experienced laparoscopic surgeons. We initially used lightweight monofilament polyester mesh (Parietex™) 4 × 20 cm. This was later changed to Titanium coated lightweight polypropylene mesh (TiLENE®) 4 × 20 cm or 4 cm × 18 cm × 1 mm biological mesh (Permacol™) in young patients. Suturing was Intracorporeal and Ethibond Excel®2/0 was used to attach the mesh to the rectum. Vicryl® 2/0 was used for Colpopexy and ProTack™ 5mm for attaching the mesh to the sacral promontory. Data concerning demographics, operative data, complications, length of stay, recurrence and patient reported outcome were gathered from a prospective data base. Data are presented as median, range and proportions. Results Median age, ASA and BMI were 60.5 (34–78), 2 (1–3), 26.1 (20.4–33.1). Previous pelvic surgery included hysterectomy (35%), Vaginal wall repair (15%) and rectal prolapse surgery (20%). 2 patients had undergone Delorme’s procedure whereas 2 patients had previous laparoscopic suture rectopexy. 60% had Oxford prolapse grades 3/4 and rest were grade 5. Enterocele (25%), Rectocele (40%) and Middle compartment prolapse (5%) were associated. Median operative time was 229 min (175–330). Synthetic mesh was used in 16 patients (Parietex 30%, TiLENE 50%) and Permacol in 4(20%). Colpopexy was performed in 90%. 30 day mortality was zero. There were no conversions and overall complication rate was 10% (1 wound infection and 1 port site hernia). No intraoperative complications, mesh related complications or sexual dysfunction were reported. Median length of stay was 3(2–6). 17 patients (85%) had 6 months or more follow up. Median patient reported outcome for satisfaction was 9.5 on a scale of 1 to 10(2–10). One patient developed recurrence of ODS after 1 year. One patient (Permacol) developed recurrent prolapse as well as anterior and posterior vaginal prolapse after 6 months. Conclusion We suggest that experienced laparoscopic surgeons can learn and safely perform laparoscopic ventral mesh rectopexy Disclosure of interest None Declared.

Laparoscopic modified Orr-Loygue mesh rectopexy for rectal prolapse in children

AimWe present an operating technique inspired from the Orr-Loygue mesh rectopexy adapted for laparoscopy, and detail the technical steps that differ from laparoscopic posterior suture rectopexy more commonly described in the paediatric literature. MethodWe present a retrospective study of all children who underwent a modified Orr-Loygue procedure for recurrent complete rectal prolapse from 1999 to 2012 after failure of conservative treatment. Pathological conditions, technical details of the procedure (excision of the Douglas pouch, use of a prerectal non-absorbable mesh to suspend the rectum to the presacral fascia and promontory avoiding any tension on the rectal wall) and postoperative results were reviewed. ResultsEight patients were included, median age 6.5years (range, 2–17). Median symptoms duration before surgery was 14months (range, 6–24). Four patients presented with associated pathological conditions: 1 neurological impairment (Williams–Beuren syndrome), 1 severe malnutrition (mental anorexia), 1 solitary rectal ulcer with frequent bleeding, 1 syringomyelic cavity in the spinal cord. All procedures were completed laparoscopically with a median operative time of 98minutes (range, 80–125). Median hospital stay was 3.5days (range, 2–5). No postoperative constipation or recurrence was reported during the median follow-up period of 6years (range 2–13). ConclusionThe laparoscopic modified Orr-Loygue mesh rectopexy is a simple operating technique, reproducible and efficient as surgical treatment of nonresolving recurrent complete rectal prolapse in children. To avoid postoperative constipation, it is important to perform a tension-free rectopexy which can be achieved by the use of a mesh to simply suspend and not “fix” the redundant rectosigmoid. Nonetheless, a greater number of patients as well as colorectal electromyography or anorectal manometry would be necessary to prove the absence of postoperative deleterious functional disorder.

Ten-year follow up after laparoscopic suture rectopexy for full-thickness rectal prolapse

Studies have shown that recurrence rates of full-thickness rectal prolapse (FTRP) 5 years after surgery can quadruple at 10 years. This study aimed to evaluate the impact of laparoscopic suture rectopexy for FTRP on recurrence rates and functional outcome at a median follow up of 10 years. Prospectively collected data for patients who underwent laparoscopic suture rectopexy for FTRP between 1993 and 2006 were analysed. Laparoscopic rectopexy consisted of circumferential mobilization of the rectum down to the levator followed by suture suspension to promontory. Patients with preexisting constipation or who were unfit for general anaesthesia were not included. Incontinence, quality of life and constipation were assessed by validated scores. Recurrence-free curves were generated using the Kaplan-Meier method. One hundred and seventy-nine patients with a median age of 62 (15-93) years including 174 women and five men underwent laparoscopic suture rectopexy. There was no mortality. The 30-day complication rate was 4% (partial transection of the left ureter, pneumonia, urinary tract infection, urinary retention, superficial surgical site infection). Data on 172 patients (96%) were available at follow up. There were 10 recurrences of FTRP at 5-year follow up giving a crude recurrence rate of 6%. The actuarial 10-year recurrence rate was 20% (95% CI, 10.8-20.1). Follow-up continence (P < 0.0001) and quality of life were better than preoperatively: lifestyle (P < 0.001), coping (P < 0.001), self-perception (P < 0.005), embarrassment (P < 0.06). Constipation was unchanged. Laparoscopic suture rectopexy led to few complications, a recurrence rate of 20%, improved continence and quality of life with no worsening of constipation at 10 years.