Rectopexy For Full-thickness Rectal Prolapse Research Articles

Outcomes of Laparoscopic Suture Rectopexy Versus Laparoscopic Mesh Rectopexy: A Systematic Review and Meta-Analysis.

The contemporary literature provides conflicting evidence regarding the precedence of laparoscopic mesh rectopexy over laparoscopic suture rectopexy for full-thickness rectal prolapse. This study aimed to compare the clinical outcomes of mesh and suture rectopexy to improve the surgical management of complete rectal prolapse.The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to extract studies based on mesh versus suture rectopexy and published from 2001 to 2023. The articles of interest were obtained from PubMed Central, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Journal Storage (JSTOR), Web of Science, Embase,Scopus, and the Cochrane Library. The primary outcomes included rectal prolapse recurrence, constipation improvement, and operative time. The secondary endpoints included the Cleveland Clinic Constipation Score, Cleveland Clinic Incontinence Score, intraoperative bleeding, hospital stay duration, mortality, overall postoperative complications, and surgical site infection.A statistically significant low recurrence of rectal prolapse (odds ratio: 0.41, 95% confidence interval (CI) 0.21-0.80; p=0.009) and longer mean operative duration (mean difference: 27.05, 95% CI 18.86-35.24; p<0.00001) were observed in patients with mesh rectopexy versus suture rectopexy. Both study groups, however, had no significant differences in constipation improvement and all secondary endpoints (all p>0.05).The laparoscopic mesh rectopexy was associated with a low postoperative rectal prolapse recurrence and a longer operative duration compared to laparoscopic suture rectopexy. Prospective randomized controlled trials should further evaluate mesh and suture rectopexy approaches for postoperative outcomes to inform the surgical management of complete rectal prolapse.

A Case of Robotic Posterior Rectopexy for Full-thickness Rectal Prolapse.

We describe our experience with robotic posterior rectopexy for a patient with full-thickness rectal prolapse. To our knowledge, this is the first report of such a case in the literature. A 94-year-old woman presented with a history of gradually worsening rectal prolapse. On examination, we found that the rectum was completely prolapsed, and we observed a prolapsed intestinal tract. Surgery was indicated and robotic rectopexy was performed without intraoperative complications. The postoperative course was uneventful, and she was discharged 10 days after the operation. One year later, there were no signs of recurrence. Robotic surgery has become common in recent years. We used robotic surgery for rectopexy, including the suturing procedure. Suturing in robotic surgery is easier than that in laparoscopic surgery, and we demonstrated that robotic rectopexy could be safely and easily performed. The trial was registered in the UMIN clinical trial registry (number 000040378).

Laparoscopic Versus Open Rectopexy for Full-Thickness Rectal Prolapse: a Comparative Study

Abdominal rectopexy for patients with rectal prolapse is well suited for laparoscopic approach as no resection or anastomosis is necessary. The objective of this study was to compare efficacy and safety of laparoscopic and open abdominal Wells rectopexy in patients with full-thickness rectal prolapse. Between January 2010 and December 2015, 70 patients underwent abdominal rectopexy for full-thickness rectal prolapse. Among those 70 patients, 40 patients underwent open rectopexy and the remaining 30 patients underwent laparoscopic rectopexy based on preference of the patient. Both these groups were compared for operative time, intraoperative blood loss, post-operative pain, duration of post-operative stay, post-operative complications/morbidities, and recurrence. Mean operative time was longer in laparoscopic group compared to open group (204.83 min vs. 159 min; p < 0.001), mean intraoperative blood loss was less in laparoscopic group (43.18 ml vs. 121.13 ml; p < 0.001), post-operative pain was milder in laparoscopic group at 12 h, 24 h, and 48 h. Mean hospital stay post-operatively is shorter in the laparoscopic group (4.53 vs. 8.15 days; p < 0.001), complications/morbidity were lesser in the laparoscopic group (p < 0.05). Recurrence was observed in two patients in open rectopexy group and one patient in the laparoscopic group, p value is .733 which is statistically not significant. This study demonstrated significant differences in favor of laparoscopic rectopexy. To conclude the laparoscopic approach may be considered as a better approach for rectopexy in patients with full-thickness rectal prolapse.

Correction to: Short-term outcome of laparoscopic versus robotic ventral mesh rectopexy for full-thickness rectal prolapse. Is robotic superior?

The authors wish to clarify a number of points that were incorrectly stated in the original article. These changes do not invalidate the article.

Long-term outcome of laparoscopic rectopexy for full-thickness rectal prolapse.

The aim of this study was to assess the long-term outcomes of laparoscopic rectopexy for full-thickness rectal prolapse (FTRP). Data of a prospectively maintained database were analysed. A structured telephone interview was conducted to assess a consecutive series of long-term outcomes of an unselected population who had laparoscopic rectopexy at a single centre between April 2006 and April 2014. The primary outcome was recurrence of FTRP. Secondary outcomes were functional outcomes and morbidity associated with the procedure. A total of 80 patients (74 female, median age of 66 years, range 23-96years) underwent a laparoscopic rectopexy, of whom 35 (44%) were for recurrent prolapse. Seventy-two patients (90%) had a posterior suture rectopexy, six (8%) had a ventral mesh rectopexy, one (1%) had a combination of both procedures, and one (1%) had a posterior suture rectopexy with a sacrocolpopexy. There was no conversion to open surgery. Three patients (4%) needed reoperation within 30days after surgery: two due to small bowel obstruction and one for a suspected port site hernia. Seventy-four patients (93%) were available for either clinical follow-up (FU) or telephone interview and there were 17 (23%) recurrences of FTRP at the median FU of 57months (range 1-121months). The median time to recurrence was 12months (range 1-103months). Recurrence of FTRP was seen in nine patients (12%) within 1year following surgery. A history of multiple previous prolapse repairs increased the risk of prolapse recurrence (odds ratio 8.33, 95% confidence interval 1.38-50.47, p = 0.020). Based on clinical follow-up of 71 patients up to 1year, there were 41 patients (58%) who had faecal incontinence prior to rectopexy of whom two patients (5%) had complete resolution of symptoms and 14 (34%) had improvement. Laparoscopic rectopexy is a safe operation for full-thickness rectal prolapse. The durability of the repair diminished over time, particularly for patients operated on for recurrent prolapse.

Comparison between laparoscopic and open abdominal rectopexy for full-thickness rectal prolapse: controlled clinical trial

Background: Abdominal rectopexy is an appropriate treatment option for full-thickness rectal prolapse (FTRP). Our aim is to evaluate the effectiveness and surgical outcome of laparoscopic posterior mesh rectopexy in treatment of FTRP by comparing this procedure with the traditional open approach.Methods: Thirty consecutive cases with FTRP were included and subjected to abdominal posterior mesh rectopexy from September 2013 to February 2016 at Sohag University Hospital. Thirteen patients were managed laparoscopically and 17 patients underwent open posterior mesh repair. Demographic data and surgical outcome were compared in both groups.Results: Laparoscopic group showed an earlier tolerance to oral feeding (1.26±0.42 versus 2.16±1.36 days, p=0.03), and earlier hospital discharge and return to work (5.63±2.91 versus 8.24±4.64 days, p=0.016, 18.28±2.61 versus 28.64±3.82 days, p=0.032, respectively). The mean consumed postoperative analgesics per day was less among laparoscopic group (1.63±16.2 versus 2.68±34.21 ampoule/day, p=0.012). Incidence of wound infection, wound dehiscence, prolonged ileus and postoperative chest infection were more in open group. There were significant postoperative improvement of continence status, rectal bleeding and abdominal pain in each group. Incidence of postoperative constipation was slightly increased in both groups, but without significant difference. Recurrence occurred in one case only in open group. There were no mortalities in both groups.Conclusions: Laparoscopic posterior mesh rectopexy for FTRP can be done safely even in elderly patients. It offers less postoperative pain, low incidence of postoperative morbidities, early hospital discharge and return to work, in addition to cosmetically better outcome. Laparoscopic rectopexy has the same functional outcome as open technique.

Anterior rectopexy for full-thickness rectal prolapse: Technical and functional results.

To assess effectiveness, complications, recurrence rate, and recent improvements of the anterior rectopexy procedure for treatment of total rectal prolapse. MEDLINE, PubMed, EMBASE, and other relevant database were searched to identify studies. Randomized controlled trials, non-randomized studies and original articles in English language, with more than 10 patients who underwent laparoscopic ventral rectopexy for full-thickness rectal prolapse, with a follow-up over 3 mo were considered for the review. Twelve non-randomized case series studies with 574 patients were included in the review. No surgical mortality was described. Conversion was needed in 17 cases (2.9%), most often due to difficult adhesiolysis. Twenty eight patients (4.8%) presented with major complications. Seven (1.2%) mesh-related complications were reported. Most frequent complications were urinary tract infection and urinary retention. Mean recurrence rate was 4.7% with a median follow-up of 23 mo. Improvement of constipation ranged from 3%-72% of the patients and worsening or new onset occurred in 0%-20%. Incontinence improved in 31%-84% patients who presented fecal incontinence at various stages. Evaluation of functional score was disparate between studies. Based on the low long-term recurrence rate and favorable outcome data in terms of low de novo constipation rate, improvement of anal incontinence, and low complications rate, laparoscopic anterior rectopexy seems to emerge as an efficient procedure for the treatment of patients with total rectal prolapse.

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.

The evidence base for rectal prolapse surgery: is resection rectopexy worth the risk?

The optimal operation for rectal prolapse is unclear. Various options exist. Broadly, one can carry out the operation via a perineal or abdominal approach. If perineal, should it be a Delormes or rectosigmoidectomy combined with a levatorplasty or not? If abdominal, should it be open or laparoscopic and should the rectum be simply mobilised or fixed? If fixed, what with and where from and to? Should the lateral ligaments be divided or preserved and should the redundant sigmoid be resected? With such a huge variation in techniques, what is the evidence that will tell us what the best approach for prolapse surgery is? Unfortunately, the literature is full of poor quality data mainly from case series and expert opinion. So the first step must be to concentrate on only the quality comparative data in the form of randomised controlled trials. Can this data tell us anything? The next step is to decide what outcome to assess. The obvious outcome is recurrence. When considering the two broad approaches, there is a perception that an abdominal procedure will result in a lower incidence of recurrence. Indeed, the recurrence rate for any perineal procedure may be greater than 40 % if the patient is followed up for long enough [1]. Is there good quality comparative data to back up this perception that the abdominal procedure is more robust? Two randomised trials have taken on this comparison [1, 2]. Both have inadequate numbers of patients to reach any meaningful conclusion, but for the numbers that have been examined no difference in recurrence was seen for either approach. The most recent trial failed to recruit adequate numbers despite the trial being multicentre, indeed multinational, and running for many years. Herein lies the problem with such trials. Surgeons are inclined to individualise when it comes to approach, with the perineal procedure, perhaps done under regional anaesthetic, reserved for elderly frail patients, and the abdominal approach indicated for younger patients who can tolerate a more invasive procedure and have potentially many more years of life. Equipoise does not therefore exist, and any trial becomes very difficult to recruit to. But perhaps it is time for a readjustment of this surgical dogma; the advent of laparoscopic techniques means that elderly patients can undergo abdominal procedures without an increase in complications [3]. If we assume the decision has been made to carry out an abdominal approach, is there any evidence to suggest how to carry out the operation? In terms of recurrence there probably is not. However, one large reasonably welldesigned trial has shown that the rectum cannot simply bemobilised; it has to be fixed to reduce recurrence [4]. However, recurrence is not the only important outcome. For instance, in terms of recovery, it is clear that a laparoscopic approach results in shorter postoperative stay and actually reduces overall costs [5]. Constipation is another important outcome, and the common perception is that abdominal rectopexy alone will increase the incidence of constipation in many patients, justifying the need for resection to be combined with the rectopexy [6]. Is this true? Is the added possibility of anastomotic breakdown, even if rare, really worth the risk? The study by El Muhtaseb et al. [7] would suggest it is not, with resection rectopexy failing to correct abnormal transit Comment on El Muhtaseb et al.: Colonic transit before and after resection rectopexy for full-thickness rectal prolapse (doi:10.1007/s10151-013-1053-4).

Colonic transit before and after resection rectopexy for full-thickness rectal prolapse

The objective of this study was to measure the change in colonic transit time after resection rectopexy for complete rectal prolapse. We prospectively carried out isotope colonic transit studies before resection rectopexy in 38 patients with full-thickness complete rectal prolapse and invited them to attend for a postoperative transit study at least 1year after resection rectopexy. Preoperatively, 27 (70%) patients had abnormally prolonged colonic transit times, while 11 had normal colonic transit. Twenty-two (61%) patients agreed to attend for a three-day colonic transit study. Resection rectopexy failed to correct delayed colonic transit in all patients with abnormal preoperative tests, while 4 patients developed new delayed transit and 2 with normal transit were unchanged. The study suggests that most prolapse patients have a pan-colonic motility disorder that is not corrected by rectopexy and resection of most of the left colon. If resection rectopexy fails to correct abnormal transit, this study questions the rationale for continuing to offer resection and supports less invasive surgical procedures such as ventral rectopexy.

Focus on abdominal rectopexy for full-thickness rectal prolapse: meta-analysis of literature

Laparoscopic rectopexy to treat full-thickness rectal prolapse has proven short-term benefits, but there are few long-term follow-up and functional outcome data available. Using meta-analysis techniques, this study was designed to evaluate long-term results of open and laparoscopic abdominal procedures to treat full-thickness rectal prolapse in adults. A literature review was performed using the National Library of Medicine's PubMed database. All articles on abdominal rectopexy patients with a follow-up longer than 16 months were considered. The primary end point was recurrence of rectal prolapse, and the secondary end points were improvement in incontinence and constipation. A random effect model was used to aggregate the studies reporting these outcomes, and heterogeneity was assessed. Eight comparative studies, consisting of a total of 467 patients (275 open and 192 laparoscopic), were included. Analysis of the data suggested that there is no significant difference in recurrence, incontinence and constipation improvement between laparoscopic abdominal rectopexy and open abdominal rectopexy. Considering non-comparative trials, the event rate for recurrence was similar in open and laparoscopic suture rectopexy studies and in open and laparoscopic mesh rectopexy trials. Improvement in constipation after the intervention was not statistically significant except for open mesh repair; postoperative improvement in incontinence was statistically significant after laparoscopic procedures and open mesh rectopexy. Laparoscopic abdominal rectopexy is a safe and feasible procedure, which may compare equally with the open technique with regard to recurrence, incontinence and constipation. However, large-scale randomized trials, with comparative, strong methodology, are still needed to identify outcome measures accurately.

Laparoscopically-Assisted Resection Rectopexy for Rectal Prolapse: Ten Years' Experience

This study has been undertaken to audit a single-center experience with laparoscopically-assisted resection rectopexy for full-thickness rectal prolapse. The clinical outcomes and long-term results were evaluated. The data were prospectively collected for the duration of the operation, time to passage of flatus postoperatively, hospital stay, morbidity, and mortality. For follow-up, patients received a questionnaire or were contacted. The data were divided into quartiles over the study period, and the differences in operating time and length of hospital stay were tested using the Kruskal-Wallis test. Between March 1992 and October 2003, a total of 117 patients underwent laparoscopic resection rectopexy for rectal prolapse. The median operating time during the first quartile (representing the early experience) was 180 minutes compared with 110 minutes for the fourth quartile (Kruskal-Wallis test for operating time = 35.523, 3 df, P < 0.0001). Overall morbidity was 9 percent (ten patients), with one death (<1 percent). One patient had a ureteric injury requiring conversion. One minor anastomotic leak occurred, necessitating laparoscopic evacuation of a pelvic abscess. Altogether, 77 patients were available for follow-up. The median follow-up was 62 months. Eighty percent of the patients reported alleviation of their symptoms after the operation. Sixty-nine percent of the constipated patients experienced an improvement in bowel frequency. No patient had new or worsening symptoms of constipation after surgery. Two (2.5 percent) patients had full-thickness rectal prolapse recurrence. Mucosal prolapse recurred in 14 (18 percent) patients. Anastomotic dilation was performed for stricture in five (4 percent) patients. Laparoscopically-assisted resection rectopexy for rectal prolapse provides a favorable functional outcome and low recurrence rate. Shorter operating time is achieved with experience. The minimally invasive technique benefits should be considered when offering rectal prolapse patients a transabdominal approach for repair, and emphasis should now be on advanced training in the laparoscopic approach.

Laparoscopic rectopexy for full-thickness rectal prolapse: a single-institution retrospective study evaluating surgical outcome

The laparoscopic approach promises to become the gold standard for the transabdominal management of full-thickness rectal prolapse. The aim of this study was to review our experience and to highlight the functional results achieved with this new technique. Forty-eight patients with full-thickness external prolapse underwent laparoscopic repair between February 1997 and February 2003. All patients underwent preoperative evaluation of their rectal function. Patients with isolated rectal ulcer without prolapse or with internal prolapse and patients deemed by the anesthesiologist to be unfit for general anesthesia were excluded from the study. The laparoscopic technique was either a mesh rectopexy without resection (n = 35) or a suture rectopexy with sigmoid resection (n = 13). Patients with intractable constipation preceding the development of the rectal prolapse were advised to have a resection-rectopexy. In the postoperative follow-up, attention was paid to mortality, morbidity, recurrent prolapse, incontinence, and constipation. Follow-up was done by clinical review and postal questionnaire. There were no deaths and no septic or anastomotic complications. The postoperative morbidity rate was 5%. Oral intake was started on postoperative day 1. Discharge from the hospital was on postoperative day 4 in patients without sigmoid resection and on postoperative day 7 in patients with sigmoid resection. Two patients (4%) developed recurrent total prolapse during a median follow-up period of 36 +/- 15 months (range, 7-77). The functional results were good or excellent in 72% of the cases, without digitations or dyschesia. Continence was improved in 31% of the patients and remains unchanged in 64% of them. In 11 patients (23%), constipation was worsened by the procedure. Laparoscopic rectopexy with or without resection is both safe and effective. Advantages include low-morbidity, improved cosmesis, the rapid return of intestinal function, early discharge from hospital, and a low recurrence rate. The fecal continence score is improved; however, constipation is frequently worsened.