Outcome Of Laparoscopic Ventral Rectopexy Research Articles

Does Postoperative Anxiety/Depression Impair the Long-Term Functional Outcomes of Laparoscopic Ventral Rectopexy for Obstructed Defecation?

Purpose: This study aimed to investigate the relationship between postoperative anxiety/depression and functional outcomes of laparoscopic ventral rectopexy (LVR) for obstructed defecation (OD). Methods: Patients who received LVR for OD between March 2014 and July 2020 were enrolled. Patient demographics were recorded before surgery. The validated Cleveland Clinic Constipation Score (CCCS) and Patient Assessment of Constipation Quality of Life (PAC-QoL) were evaluated to assess functional outcomes and QoL, respectively. The self-rating anxiety scale and self-rating depression scale were used to measure anxiety and depression, respectively. Results: Twenty-five patients were recruited. Significant improvement was found at last available follow-up (LAFU) in CCCS (P = .001), and three PAC-QoL subsets, physical discomfort (P = .003), satisfaction (P = .014), and worries/concerns (P = .033) during follow-up of 60 (11-84) months. In the patients with anxiety/depression (n = 11), significant improvement was found at LAFU in CCCS (P = .024) and the PAC-QoL subset, psychosocial discomfort (P = .038). In the patients without anxiety/depression (n = 14), improvement was found in CCCS (P = .009) and the PAC-QoL subset, physical discomfort (P = .018). Conclusion: The long-term functional outcomes of LVR for OD in patients with overt pelvic structural abnormalities are not undermined by postoperative anxiety/depression.

Outcome of Laparoscopic Ventral Rectopexy for Patients with Enterocele

Outcome of Laparoscopic Ventral Rectopexy for Patients with Enterocele

What does the future hold for ventral rectopexy?: 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

What does the future hold for ventral rectopexy?: 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

Midterm functional outcome after laparoscopic ventral rectopexy for external rectal prolapse.

IntroductionAlthough long‐term crude outcomes of laparoscopic ventral rectopexy for external rectal prolapse (ERP) have been documented, repetitive functional and quality of life (QOL) assessments are scarce. This study assessed midterm annual functional results and QOL after laparoscopic ventral rectopexy for ERP.MethodsThis study consisted of 58 patients and was a retrospective analysis of prospectively collected data. The Fecal Incontinence Severity Index, the Constipation Scoring System, and QOL instruments (ie 36‐item Short‐Form Health Survey and Fecal Incontinence Quality of Life scale) were administered before and after operation.ResultsThere was no mortality or major morbidity. After a median follow‐up of 49 months (6‐92 months), recurrence of ERP was noted in one patient (2%). There were no mesh‐related complications. The median Fecal Incontinence Severity Index score was significantly reduced at 3 months (34 [10‐61] vs 12 [0‐50], P < 0.0001) and remained significantly reduced for 5 years. The median Constipation Scoring System score was significantly reduced at 3 months (14 [9‐20] vs 7 [0‐16], P < 0.0001) and remained significantly reduced for 4 years. No patients developed new‐onset constipation. All of the Fecal Incontinence Quality of Life scales significantly improved overtime for 4 years. All of the 36‐item Short‐Form Health Survey scales were significantly improved at 3 and 6 months, but none of the scales significantly improved after 2 years.ConclusionLaparoscopic ventral rectopexy for ERP was associated with low morbidity, low recurrence, and a midterm improvement in function and fecal incontinence‐specific QOL.

Short-term outcomes of laparoscopic ventral rectopexy for obstructed defecation in patients with overt pelvic structural abnormalities—a Chinese pilot study

As laparoscopic ventral rectopexy (LVR) gained increasing popularity in the past decade, studies from non-western area remain rare. The aim of this pilot study is to evaluate the efficacy and safety of LVR for obstructed defecation (OD) in Chinese patients with overt pelvic structural abnormalities. A series of 19 consecutive patients is presented undergoing LVR for OD. All patients showed various forms of pelvic structural abnormalities which were verified by dynamic defecography exam. Data was prospectively recorded and the functional outcomes were evaluated using the Cleveland Clinic Constipation Score (CCCS) and Patients Assessment of Constipation Quality of Life Score (PAC-QoL). Pelvic structural abnormalities of the 19 patients included external rectal prolapse (ER) in 10.5% (2/19), high grade internal rectal prolapse (IR) in 57.8% (11/19), rectocele in 52.6% (10/19), enterocele in 15.7% (3/19), cystocele/vaginal prolapse in 15.7 (3/19), descending perineum (DP) in 63.5% (12/19). 89.4% patients (17/19) showed at least two co-existed abnormalities and 15.7% (3/19) showed multicompartmental abnormalities. The mean follow-up was 9months (range 1-18). No mesh-related complication was observed. At last available follow-up (LAFU), improvement of OD symptom was observed in 15 (78.9%) patients, the mean scores of CCCS decreased from 17 to 10 (p<0.05), all four subsets of PAC-QoL scores improved, and three of them (physical discomfort, worries and concerns, satisfaction) showed statistical significance (p<0.05). Laparoscopic ventral rectopexy appears to be a safe and effective procedure for obstructed defecation in Chinese patients with overt pelvic structural abnormalities in short-term follow-up.

PWE-384 Comparison of functional outcomes after laparoscopic ventral mesh rectopexy and resection rectopexy

Introduction Laparoscopic ventral mesh rectopexy (LVMR) repairs rectal prolapse and rectocoele by an autonomic nerve-sparing rectal dissection, using mesh reinforcement. The aim of this retrospective series was to assess functional outcomes of laparoscopic VMR and compare with an historical control group having had open resection rectopexy. Method Between 2012 and 2015, 64 patients had LVMR for rectal prolapse, functional obstructed defaecation (FOD) caused by rectocoele and/or faecal incontinence (FI). 31 out of 64 patients underwent preoperative imaging by MRI defaecating proctogram. Biological mesh was used in 51 out of 64 (80%) patients. We reviewed electronic patient records for outcomes and telephoned patients for further review of symptoms after surgery. Follow-up ranged from 1–33 months, median 12 months. Outcomes were also analysed in 68 patients who had open resection rectopexy between 1999 and 2009 (range 5–14 years, median 8 years). Results The conversion rate to open VMR was 7 out of 64 (11%) patients, due to adhesions from previous surgery. In this series of laparoscopic VMR, a total of 4 out of 64 patients required re-intervention, 2 for complications and 2 for technical failure (ie. early recurrent rectal prolapse and rectocoele). At 5 months there were no infections, fistulae or pain complications. In all patients with FI (n = 32), there was improvement in symptoms at initial follow-up. FOD resolved in 43 out of 44 patients. Outcomes from open resection rectopexy include FI (11 patients), constipation (8), FOD due to rectocoele (7), adhesional small bowel obstruction (7, of which 3 required laparotomy), uterovaginal prolapse (6), recurrent rectal prolapse (4) and incisional hernia (1). Conclusion Laparoscopic VMR is an effective technique for repairing rectocoele, rectal prolapse, and tricompartmental pelvic floor decent. It has a low complication rate with high resolution of symptoms at early follow-up (median 12 months). The longer term follow-up for open resection rectopexy suggested a higher level of recurrent prolapse, FI and FOD. Longer follow-up data on laparoscopic VMR patients is underway. This series of laparoscopic VMR repair for rectal prolapse and/or rectocoele has demonstrated early improvement in functional outcome overall and when compared with historical open resection rectopexy operations. Disclosure of interest None Declared. References D9Hoore A, Penninckx F. Laparoscopic ventral recto (colpo)pexy for rectal prolapse: surgical technique and outcome for 109 patients. Surg Endosc. 2006;20:1919–1923 D9Hoore A, Cadoni R, Penninckx F. Long-term outcome of laparoscopic ventral rectopexy for total rectal prolapse. Br J Surg. 2004;91:1500–1505

Impact of slow transit constipation on the outcome of laparoscopic ventral rectopexy for obstructed defaecation associated with high grade internal rectal prolapse

Limited literature exists on whether slow colonic transit adversely influences the results of outlet obstruction surgery. We compared the functional results of laparoscopic ventral rectopexy (LVR) for obstructed defaecation secondary to high grade internal rectal prolapse in patients with normal and slow colonic transit. Consecutive patients suffering from obstructed defaecation associated with an internal rectal prolapse, who underwent an LVR between 2007 and 2011, were identified from a prospective database. All patients underwent preoperative defaecating proctography, anorectal manometry and colonic transit studies. Symptoms were assessed preoperatively and at 12months after operation using a standardized questionnaire incorporating the Patient Assessment of Constipation Symptoms (PAC-SYM) questionnaire, the Fecal Incontinence Severity Index (FISI), the Patient Assessment of Constipation Quality of Life (PAC-QOL) scale and the Gastrointestinal Quality of Life Index (GIQLI). In all, 151 patients underwent LVR, 109 with normal and 42 with slow colonic transit. Preoperatively there was no significant difference between the two groups in age, sex, PAC-SYM score or FISI score. The PAC-SYM and FISI scores were significantly reduced in both groups at 12months (P<0.001). When comparing the change from baseline of PAC-SYM between patients with and without slow transit constipation, a significant difference was observed (P=0.030) with changes of 58% and 40%. Quality of life (GIQLI and PAC-QOL) was equally improved in both groups. Quality of life improvement was less in patients with right colonic stasis. Slow colonic transit has no adverse impact on function and quality of life after LVR for obstructed defaecation due to high grade internal rectal prolapse.