Rectopexy Group Research Articles

Quality of Life, Functional Outcomes, and Recurrence After Resection Rectopexy Versus Ventral Mesh Rectopexy for Rectal Prolapse Repair.

Resection rectopexy and ventral mesh rectopexy are widely accepted surgical options for the treatment of rectal prolapse, however reports on long-term recurrence rates and functional outcomes are lacking. We compared quality of life, long-term functional outcomes and prolapse recurrence after resection rectopexy versus ventral mesh rectopexy. We retrospectively reviewed our prospectively collected rectal prolapse surgery database. Patients who underwent resection rectopexy or ventral mesh rectopexy at our center between 2009 and 2016 were included. Two hundred twenty patients were included, of which 208 (94%) female; 85 (39%) underwent resection rectopexy, 135 (61%) ventral mesh rectopexy. Prolapse recurrence. The resection rectopexy group was younger (median 52 vs 60 years old, p = 0.02) and had more open procedures (20% vs 9%, p < 0.001). After a median follow-up of 110 (IQR 94 - 146) months for resection rectopexy and 113 (87 - 137) for ventral mesh rectopexy, recurrences occurred in 21 (26%) in the resection rectopexy and 50 (39%) in the ventral mesh rectopexy group (p = 0.041). Median time to recurrence was 44 (18 - 80) months in the resection rectopexy group and 28.5 (11 - 52.5) in the ventral mesh rectopexy group (p = 0.14). There were no differences in the recurrence rate for primary prolapses in resection rectopexy vs ventral mesh rectopexy. Recurrence rate for re-do prolapses was higher in the ventral mesh rectopexy group 63% at 10 years, versus 25% in resection rectopexy group (p = 0.006). Functional outcomes were similar between the two groups. Retrospective review, recall bias. Long-term quality of life and functional outcomes after resection rectopexy and ventral mesh rectopexy were comparable. Ventral mesh rectopexy was associated with a higher prolapse recurrence rate after recurrent rectal prolapse repair. See Video Abstract.

AN EVALUATION OF CLINICAL OUTCOMES AFTER ABDOMINAL MESH RECTOPEXY &amp; DELORME'S PROCEDURE FOR RECTAL PROLAPSE AT TERTIARY HEALTH CARE CENTER

Background: Rectal prolapse is protrusion of rectum through anal canal, and proccidentia ~ complete prolapse is the term used when full thickness rectal wall prolapse . 30 patients presenting with Materials and methods: mass per rectum were evaluated &amp; diagnosed clinically as having rectal prolapse were included in the study. The recurrence rate for the abdominal mesh Results: rectopexy is considered to be lower than Perineal Delorme's procedure. There was no recurrence in the rectopexy group. There was 1 recurrence (10%) in Delorme's group. .Better outcomes achieved when treatment individualized to Conclusion: each patient. Abdominal rectopexy for patients who can tolerate laparotomy &amp; signicant constipation. .Delorme's considered in young patients with short prolapse but with acceptable recurrence rate.

Tunneling of Mesh during Ventral Rectopexy: Technical Aspects and Long-Term Functional Results

Avoiding the extensive damage of pelvic structures during ventral rectopexy could minimize secondary disfunctions. The objective of our observational study is to assess the safety and functional efficacy of a modified ventral rectopexy. In the modified ventral rectopexy, a retroperitoneal tunnel was created along the right side of rectum, connecting two peritoneal mini-incisions at the Douglas pouch and sacral promontory. The proximal edge of a polypropylene mesh, sutured over the ventral rectum, was pulled up through the retroperitoneal tunnel and fixed to the sacral promontory. In all patients, radiopaque clips were placed on the mesh, making it radiographically "visible". Before surgery and at follow up visits, Altomare, Longo, CCSS, PAC-SYM, and CCFI scores were collected. From March 2010 to September 2021, 117 patients underwent VR. Modified ventral rectopexy was performed in 65 patients, while the standard ventral rectopexy was performed in 52 patients. The open approach was used in 97 cases (55 and 42 patients in modified and standard VR, respectively), while MI surgery was used in 20 cases (10 and 10 patients in modified and standard VR, respectively). A slightly shorter operative time and hospital stay were observed following modified ventral rectopexy (though this was not statistically significant). Similar overall complication rates were registered in the modified vs. standard ventral rectopexies (4.6% vs. 5.8%, p = 0.779). At follow-up, the Longo score (14.0 ± 8.6 vs. 11.0 ± 8.2, p = 0.042) and "delta" values of Altomare (9.2 ± 6.1 vs. 5.9 ± 6.3, p = 0.008) and CCSS (8.4 ± 6.3 vs. 6.1 ± 6.1, p = 0.037) scores were significantly improved in the modified ventral rectopexy group. A similar occurrence of symptoms recurrence was diagnosed in the two groups. Radiopaque clips helped to accurately diagnose mesh detachment/dislocation. The proposed modified VR seems to be feasible and safe. Marking the mesh intraoperatively seems useful.

A COMPARATIVE STUDY ON LAPAROSCOPIC VERSUS OPEN MESH RECTOPEXY FOR FULL THICKNESS RECTAL PROLAPSE

To evaluate the efcacy and safety of laparoscopic versus open mesh rectopexy for total rectal prolapse. A retrospective review was conducted for 12 patients undergoing laparoscopic versus open mesh rectopexy for total rectal prolapse between November 2019 and November 2021. Laparoscopic rectopexy (n = 6) and open surgery (n = 6) were performed. Two groups were matched with regards to age, gender, body mass index (BMI) and American Society of Anesthesiologists (ASA) score. Mortality was zero in each group. There were insignicant inter-group differences in operative duration, postoperative complication, rate of long-term recurrence and improvement of incontinence and constipation. Perioperative blood loss and postoperative hospital stay were signicantly shorter in the laparoscopic rectopexy group. Laparoscopic mesh rectopexy is as safe and efcient as open rectopexy. And both are suitable for senile patients. Longterm outcomes are similar for two groups, but the laparoscopic group has better short-term outcomes.

Does ventral mesh rectopexy at the time of sacrocolpopexy prevent subsequent posterior wall prolapse?

Objective:To determine whether ventral mesh rectopexy at the time of sacrocolpopexy reduces the rate of future posterior wall prolapse.Material and Methods:This was a retrospective cohort study of women with pelvic organ prolapse (POP) who underwent sacrocolpopexy or without concomitant rectopexy at a single community hospital from December 1, 2015 to June 30, 2019. Preoperative pelvic organ prolapse quantification (POP-Q) and urodynamic testing was used in evaluation of POP. Patients were followed for 12-weeks postoperatively and a 12-week postoperative POP-Q assessment was completed. The incidence of new or recurrent posterior prolapse was compared between cohorts.Results:Women with POP (n=150) were recruited, of whom 41 (27.3%) underwent sacrocolpopexy while the remainder (n=109, 72.7%) did not receive rectopexy. Patient demographics did not statistically differ between cohorts. Post-surgical posterior wall prolapse was reduced in the robotic assisted sacrocolpopexy (RASC) + rectopexy group compared to RASC alone, however this did not reach statistical significance. There were no patients who underwent concomitant rectopexy and RASC that needed recurrent posterior wall prolapse surgery, compared to eight-percent of patients that underwent isolated RASC procedures.Conclusion:Our findings suggest a reduction in the need for subsequent posterior wall surgery when rectopexy is performed at the time of sacrocolpopexy. In our study, no future surgery for POP was found in the concomitant sacrocolpopexy and rectopexy group, while a small proportion of the RASC only group required future POP surgery. Our study, however, was underpowered to elucidate a statistically significant difference between groups. Future larger studies are needed to confirm a reduced risk of posterior wall prolapse in patients who undergo concomitant RASC and rectopexy.

Laparoscopic Pelvic Organ Prolapse Suspension (Pops) Versus Laparoscopic Ventral Mesh Rectopexy for Treatment of Rectal Prolapse: Prospective Cohort Study.

This study aimed to compare ventral mesh rectopexy (VMR) and pelvic organ prolapse suspension surgery (POPS) in management of patients presenting with rectal prolapse. Our study was a prospective cohort trial in which 120 female patients with complete rectal prolapse were included, 60 patients had had VMR and the other 60 had had POPS as a surgical management for complete rectal prolapse. Results had been compared 6months postoperatively regarding operative time, postoperative pain, hospital stay, complications of surgery including recurrence of the rectal prolapse, the efficacy of each operation in treatment of rectal prolapse and associated symptoms. The patients were assessed 6months postoperatively. There was no significant statistical difference regarding hospital stay and postoperative pain. Operative time was significantly shorter in POPS in comparison with VMR (P value < 0.05). VMR showed slight improvement regarding constipation and continence scores; however, this was statistically significant. VMR showed less complications compared to POPS. Complications with rectopexy happened only with 4 patients compared to 24 patients in POPS groups, 2 cases of recurrence in rectopexy group compared to 6 cases of recurrence in POPS. POPS is comparable to VMR in management of rectal prolapse and in improving the ODS symptoms. Thus, POPS can be used as easier, faster option to treat rectal prolapse in selected patients.

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.

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.

Bowel function after laparoscopic posterior sutured rectopexy versus ventral mesh rectopexy for rectal prolapse: a double-blind, randomised single-centre study

Laparoscopic ventral mesh rectopexy for rectal prolapse has been widely used over the past decade to reduce postoperative functional bowel disorders. We aimed to compare changes in functional outcome 12 months after laparoscopic ventral mesh rectopexy versus laparoscopic posterior sutured rectopexy in patients with rectal prolapse. In this double-blind, randomised trial, consecutive patients aged 18 years or older at a single centre in Denmark with full-thickness rectal prolapse were randomly assigned (1:1) to either laparoscopic ventral mesh rectopexy or laparoscopic posterior sutured rectopexy by drawing numbers from opaque envelopes, in blocks of four for patients with or without preoperative constipation. Functional assessment was done preoperatively and 12 months postoperatively. The primary outcome was preoperative-to-postoperative change in obstructed defecation syndrome (ODS) score. Patients and those assessing the outcomes were masked to the procedure. The primary analysis was done in the per-protocol population. Safety outcomes were assessed in the entire cohort. The trial is registered with ClinicalTrials.gov, number NCT00946205. From Nov 1, 2006, to Jan 31, 2014, 75 consecutive patients were assigned to laparoscopic posterior sutured rectopexy (n=37) or laparoscopic ventral mesh rectopexy (n=38). Eight patients withdrew consent to follow-up, leaving 34 patients in the posterior sutured rectopexy group and 33 in the ventral mesh rectopexy groups for the primary analysis. The preoperative-to-postoperative reduction in ODS score was 1·97 (95% CI 0·01 to 3·93) in patients who received ventral mesh rectopexy and 2·18 (-0·14 to 4·49) in those who received posterior sutured rectopexy (difference -0·21 [-3·19 to 2·78]; p=0·890). Postoperative surgical complications of Clavien-Dindo grade II or worse were reported in one (3%) of 38 patients in the ventral mesh rectopexy group (ureteral injury resulting in urine leakage, and a psoas abscess) and one (3%) of 37 patients in the posterior sutured rectopexy group (haematoma and pelvic abscess). Two (5%) patients in the posterior sutured rectopexy group developed recurrence within 12 months compared with none in the ventral mesh rectopexy group (p=0·305). Functional outcome measured by preoperative-to-postoperative change in ODS score was not significantly superior in patients who underwent ventral mesh rectopexy compared with those who had posterior sutured rectopexy. Additional, large, randomised, multicentre studies with long-term outcomes are warranted. None.

PTH-265 Outcomes of redo rectopexy with and without resection for recurrent rectal prolapse: are the results comparable to the primary surgery?

<h3>Introduction</h3> The surgical approach to recurrent full-thickness rectal prolapse is more complicated than for primary full thickness rectal prolapse. However, it has not been reported that redo rectopexy for recurrent full thickness rectal prolapse is as safe and feasible as primary rectopexy. This study evaluated the safety and efficacy of redo rectopexy with and without resection for recurrent full thickness rectal prolapse. <h3>Method</h3> After IRB approval, 144 consecutive patients [138 females; mean age 57 (range, 16–83) years] with primary [n = 112; 108 females, mean age 56 (range, 16–80) years] or recurrent [n = 32; 30 females, mean age 58 (29–83) years] rectal prolapse who underwent rectopexy with and without resection between May 2000 and April 2014 were identified from a prospective database. Perioperative outcomes and reoperation rate due to recurrence were compared between the two groups. <h3>Results</h3> Both groups had comparable demographics, BMI, ASA scores, type of surgical approach, and comorbidities. Patients with primary rectopexy had a higher percentage of resected colon (60.7%) than did those with redo rectopexy (28.1%; <i>p = 0</i>.001). Patients had open (75 vs. 25), hand-assisted (3 vs. 1) and laparoscopic (34 vs. 6) surgery in the primary vs. redo rectopexy groups, respectively (p = 0.213). Intraoperative blood loss and length of postoperative stay were similar in both groups. The most common complication was ileus (n = 15). There was no significant difference in the postoperative complication rate (primary rectopexy 30.6% vs. redo rectopexy 37.5%; <i>p = 0</i>.521). The reoperation rate due to recurrence was significantly higher in redo rectopexy vs. primary rectopexy (12.5% vs. 1.8%; <i>p = 0</i>.022). The mean interval from primary surgery to reoperation for recurrence was 17.0 (range, 2.5–40.5) months for the redo rectopexy group and 46.8 (range, 30.0–63.7) months for the primary rectopexy. Functional data were not available. <h3>Conclusion</h3> Redo rectopexy with and without resection can be performed as safely as primary rectopexy in patients with full-thickness rectal prolapse. However, the re-reoperation rate due to recurrence of rectal prolapse is higher in redo rectopexy. <h3>Disclosure of interest</h3> None Declared.

Safety of combined abdominal sacral colpopexy and sigmoid resection with suture rectopexy: a retrospective cohort study.

This study aimed to determine if abdominal sacral colpopexy (ASC) using mesh can be safely combined with sigmoid resection and anastomosis. This is a single institution, retrospective chart review of patients who underwent combined ASC and suture rectopexy with sigmoid resection between January 1, 2007, and December 31, 2011. Charts were screened for outcome data and complications related to the placement of synthetic mesh at the time of bowel resection to include readmission and reoperation rates, infection, bowel obstruction, fistula, and mesh erosion. Outcome data for patients receiving combined procedures were compared to 2 separate cohorts of patients as follows: a group that underwent only ASC with polypropylene mesh and a group that underwent only sigmoid resection plus or minus suture rectopexy. The DINDO surgical classification system was used for each cohort to further analyze complications. There were 133 patients in the ASC only group (ASC only), 34 in the combined ASC and sigmoid resection group (Combined), and 27 in the sigmoidectomy plus rectopexy group (Colorectal only). The Colorectal only cohort had a higher rate of postoperative ileus; ASC only 3.8%, Combined 5.9%, Colorectal 22.2% (P = 0.004). There were otherwise no differences in intraoperative and postoperative complications or in the DINDO classification scores. Abdominal sacral colpopexy with placement of synthetic mesh at the time of sigmoid resection and anastomosis does not seem to increase the rate of intraoperative or postoperative complications.

Rectal Prolapse in Women-Outcomes of Perineal and Abdominal Approaches.

The aim of the study was to assess the clinical and functional results of surgical treatment of female patients with rectal prolapse. In the period of 2003-2010, the group of 86 female patients (mean age of 67 ± 10) underwent surgery due to rectal prolapse. The group of 24 patients (27.9%) suffered from mild anal incontinence. They were operated on with open sutured rectopexy (18 pts), Altemeier (45 pts) and Delorme procedure (23 pts). Prior to surgery and after operation, clinical and function results were obtained. The follow-up period amounted to 32 ± 11months. In perineal approaches, we found mortality in one patient (1.4%, Delorme) and anastomotic leak in four patients (5.9%). The recurrence rate in the perineal group was 11.8% (eight patients). We noted one recurrence in the rectopexy group (5.6%). The Altemeier procedure revealed the most significant impact on the function of the anal sphincter muscles and resting pressures (42 ± 7 vs 53 ± 9cm H2O; p = 0.0082). If anterior levatoroplasty was added, the benefits referred also to squeeze pressures (41 ± 8 vs 58 ± 9cm H2O; p = 0.006 and 42 ± 10 vs 56 ± 9cm H2O; p = 0.01). In the treatment of rectal prolapse, there is still no consensus about the operation of choice. Selection of the appropriate method should be based on clinical findings and patients' comorbidities to obtain maximal benefits and minimize the postoperative risk and failures.

Laparoscopic versus open mesh rectopexy for total rectal prolapse

To evaluate the efficacy and safety of laparoscopic versus open mesh rectopexy for total rectal prolapse. A retrospective review was conducted for 34 patients undergoing laparoscopic versus open mesh rectopexy for total rectal prolapse between January 2006 and December 2013. Laparoscopic rectopexy (n = 15) and open surgery (n = 19) were performed. Two groups were matched with regards to age, gender, body mass index (BMI) and American Society of Anesthesiologists (ASA) score. Mortality was zero in each group. There were insignificant inter-group differences in operative duration, postoperative complication, rate of long-term recurrence and improvement of incontinence and constipation. Perioperative blood loss, time to first flatus and hospital stay were significantly shorter in laparoscopic rectopexy group. Laparoscopic mesh rectopexy is as safe and efficient as open rectopexy. And both are suitable for senile patients. Long-term outcomes are similar for two groups, but laparoscopic group has better short-term outcome.

Evaluation of Clinical Outcomes after Abdominal Rectopexy and Delorme's Procedure for Rectal Prolapse: A Prospective Study.

Complete rectal prolapse is characterized by protrusion of full thickness rectal wall through the anal orifice. Despite its rarity more than 100 surgical procedures have been described and there are no good evidence based recommendations for selection of a surgical procedure. This study was conducted to evaluate the clinical outcomes of commonly used procedures for rectal prolapse at our hospital. Twenty seven patients presenting with complete rectal prolapse between May 2011 to May 2013 were included in this prospective study. Patients underwent either Abdominal rectopexy or Delorme's procedure after evaluation, based on clinical judgment of experienced surgeons. Patient characteristics, complications, post-operative length of hospitalization and clinical outcomes were assessed. Patients were followed up for a mean duration of 14 months. Seventeen patients underwent Abdominal rectopexy (Posterior mesh rectopexy), ten patients underwent Delorme's procedure. No postoperative mortalities or major complications were noted. Post operative morbidity (minor) was 17% in Abdominal rectopexy group and 10% in Delormes group 0%. Incontinence improved in all six patients (100%) in rectopexy group, four patients (80%) in Delorme's procedure group. Two patients (11%) in rectopexy group reported increase in constipation post operatively. There was one recurrence in Delorme's procedure group with no recurrences in Abdominal rectopexy group. The treatment of rectal prolapse should be individualized to achieve best results. Abdominal rectopexy can be safely applied in most of patients with minimal post operative increase in constipation and recurrence by using posterior mesh rectopexy technique. Delorme's procedure can be performed with minimal morbidity and shorter hospital stay and good functional results with acceptable recurrence rate. Delorme's can be considered as an alternative to rectopexy not only in patients unfit for laparotomy but also in individuals with a short prolpase, avoiding a laparotomy.

A single centre comparative study of laparoscopic mesh rectopexy versus suture rectopexy

AIM:The aim of our study is to compare the results of laparoscopic mesh vs. suture rectopexy.MATERIALS AND METHODS:In this retrospective study, 70 patients including both male and female of age ranging between 20 years and 65 years (mean 42.5 yrs) were subjected to laparoscopic rectopexy during the period between March 2007 and June 2012, of which 38 patients underwent laparoscopic mesh rectopexy and 32 patients laparoscopic suture rectopexy. These patients were followed up for a mean period of 12 months assessing first bowel movement, hospital stay, duration of surgery, faecal incontinence, constipation, recurrence and morbidity.RESULTS:Duration of surgery was 100.8 ± 12.4 minutes in laparoscopic suture rectopexy and 120 ± 10.8 min in laparoscopic mesh rectopexy. Postoperatively, the mean time for the first bowel movement was 38 hrs and 40 hrs, respectively, for suture and mesh rectopexy. Mean hospital stay was five (range: 4-7) days. There was no significant postoperative complication except for one port site infection in mesh rectopexy group. Patients who had varying degree of incontinence preoperatively showed improvement after surgery. Eleven out of 18 (61.1%) patients who underwent laparoscopic suture rectopexy as compared to nine of 19 (47.3%) patients who underwent laparoscopic mesh rectopexy improved as regards constipation after surgery.CONCLUSION:There were no significant difference in both groups who underwent surgery except for patients undergoing suture rectopexy had better symptomatic improvement of continence and constipation. Also, cost of mesh used in laparoscopic mesh rectopexy is absent in lap suture rectopexy group. To conclude that laparoscopic suture rectopexy is a safe and feasible procedure and have comparable results as regards operative time, morbidity, bowel function, cost and recurrence or even slightly better results than mesh rectopexy.

No Surgery for Full‐Thickness Rectal Prolapse: What Happens with Continence?

Surgery is the only validated means of treating overt rectal prolapses, but both patients and physicians may decline or postpone the surgical approach. However, little is known on the functional outcome of nonoperated rectal prolapse. The aim of the present study was to highlight the natural history of overt rectal prolapse in patients for whom surgery was avoided or delayed. A total of 206 patients complaining of full-thickness rectal prolapse were referred to a single institution that provided anorectal physiology for functional anorectal disorders. Standardized questionnaires, anorectal manometry, endosonography, and evacuation proctography constituted a prospective database. Fecal incontinence was evaluated with the Cleveland Clinic score (CCIS), and constipation was evaluated with the Knowles Eccersley Scott Symptom score (KESS). Forty-two nonoperated patients (mean age: 61 ± 16 years) were compared to those of operated patients paired according to age and gender: the mean follow-up was 44 ± 26 months. The two groups had a similar past-history, follow-up, stool frequency, and main complaints, but lower quantified symptomatic scores and a better quality of life were reported in the nonsurgical group. At the end of follow-up, the nonsurgical group did not show any variation in CCI and KESS scores. By contrast, these two scores significantly improved in the rectopexy group. Sixteen nonoperated patients experienced a degradation of their continence status with an average increase of 5 ± 4.3 points of the CCIS. The patients with a CCIS <7 at referral were likely to deteriorate as compared to those having a higher score. Patients with a symptom history longer than 4 years never improved and in two-thirds continence deteriorated throughout the follow-up. In the absence of the surgical option, patients with a 4-year duration of rectal prolapse and those with mild incontinence had no chance of improvement. These findings may be taken into account when surgery of rectal prolapse is not chosen.

Comparative outcomes of elderly patients undergoing Altemeier procedure versus laparoscopic rectopexy for rectal prolapse

AbstractIntroduction: We compared outcomes of elderly patients (&gt;70 years) who underwent the Altemeier procedure versus laparoscopic rectopexy for full‐thickness rectal prolapse.Materials and Methods: We reviewed our data from a prospective database and the medical records of patients treated at a single institution from 2002 to 2008. Patients who underwent surgery for full‐thickness rectal prolapse were evaluated.Results: Sixteen patients underwent laparoscopic rectopexy (median age 82 years; ASA 2.6), and 16 patients underwent the Altemeier procedure (median age 85 years; ASA 2.8). The Altemeier procedure patients had a significantly higher recurrence rate when compared to laparoscopic rectopexy patients (P&lt;0.045). The mean length of follow‐up was longer for the Altemeier group (20 months) compared to the laparoscopic rectopexy group (28.5 months; most recurrence (5/6) occurred &lt;1 year. The median length of specimen removed in the Altmeier group was 9.5 cm (6.5–18.5 cm). The majority of patients in both groups had preoperative fecal incontinence. Significantly more Altemeier patients reported worsening perioperative fecal incontinence at 1–3 months (p&lt;0.046). All laparoscopic rectopexy patients underwent general anesthesia while 44% of the Altemeier patients underwent regional anesthesia (p&lt;0.003). One laparoscopic rectopexy patient required reoperation for an incarcerated trocar site hernia. No other major complications occurred in either group. There was no difference in rates of minor complications.Discussion: Compared to the Altemeier procedure, laparoscopic rectopexy for elderly patients with rectal prolapse resulted in a significantly smaller recurrence rate, better perioperative fecal incontinence and an equivalent morbidity rate.

Rektumprolaps bei Erwachsenen - Ursache, Diagnostik, Therapie

Despite progress in modern surgery, the choice of the surgical procedure of rectal prolapse is regarded with controversy. Selection criteria between the abdominal or perineal approach or between rectopexy and resection rectopexy are not yet proven. This article gives a review of the literature about rectal prolapse and an analysis of the outcome of posterior rectopexy and resection rectopexy--partly conventionally and partly laparoscopically--in 25 patients with rectal prolapse III degrees and IV degrees. All except for one patient were examined during a mean follow-up of 5.5 (3.1) years for the rectopexy group and 2.1 (0.7) years for the resection rectopexy group. Recurrence occurred in one patient in each group respectively. There was no significant difference concerning the continence function (p = 0.32) and constipation (p = 0.36) between both groups. No mesh-related complications such as infection, fistula or rectum stenosis were observed. According to the review of the literature and our data, we believe that the choice of the operative procedure for rectal prolapse should be based on individual criteria. Fit patients should be offered laparoscopic procedures such as resection rectopexy and rectopexy without colonic resection.

Long-Term Results of Delorme's Procedure and Orr-Loygue Rectopexy to Treat Complete Rectal Prolapse

The aim of this study was to assess long-term outcome of Orr-Loygue rectopexy and Delorme's procedures in total rectal prolapse management. Data were collected retrospectively from 1978 to 2001. Statistical analysis was performed by chi-squared test and Student's t -test. One hundred nine patients underwent either a Orr-Loygue rectopexy (49 patients) or a Delorme's procedure (60 patients). Mean follow-up was 88 (range, 1-300) months. In the rectopexy group, the overall complication rate and the recurrence rate were 33 percent and 4 percent, respectively. In patients with preoperative constipation, this symptom was improved or completely resolved in 33 percent and worsened in 58 percent postoperatively. Seventy-three percent of patients with preoperative incontinence were continent or had continence improvement postoperatively. In Delorme's group, overall complication and recurrence rates were 15 percent and 23 percent, respectively. Mortality was 7 percent. In patients with preoperative constipation, this symptom was improved or completely resolved in 54 percent and worsened in 12.5 percent of patients postoperatively. Forty-two percent of patients with preoperative incontinence were continent or had continence improvement postoperatively. In this study, Orr-Loygue rectopexy had a lower long-term recurrence rate. However, this surgical procedure is associated with a higher complication rate. We believe that Delorme's procedure is still a valuable option in selected patients with postoperative minimal morbidity but higher recurrence rate.

Early outcomes of laparoscopic procedures performed on military personnel with total rectal prolapse and follow-up.

Total rectal prolapse is a disorder frequently associated with constipation and anal incontinence. The aim of this study was to evaluate the outcomes of the complications, pain management, hospital stay, constipation, and anal functions of the patients undergoing 2 types of laparoscopic surgical approaches. In this study, 33 patients underwent either laparoscopic rectopexy or hand-assisted laparoscopic resection rectopexy. Preoperative colonic transit time, defecation, postoperative pain scoring, pre-postoperative evaluation of the anal function, and the changes in constipation and relating symptoms were assessed. Postoperative evaluation had been performed at the sixth week and the twelfth month. Median operation time was 137 minutes for rectopexy and 230 minutes for resection rectopexy group. Median postoperative hospital stay was 3 days for patients with rectopexy and 7 days for patients with resection rectopexy. Patients needed painkillers in short postoperative period for pain management in both groups. Continence was improved in 11 of 13 patients (84.6%) in a year after laparoscopic surgery. In 15 patients (45.5%), preoperative constipation either remained in the same or became worse in 7 (21.1%) in a year after surgery. No patient developed recurrence in the median follow-up period, which was about 15 months. Laparoscopic rectopexy and resection rectopexy in the young aged patients working the Army are carried out with less morbidity rate. We eliminated the total prolapse and cure incontinence in almost all patients. In addition to constipation was reduced by laparoscopic surgical approaches in a short time hospitalization with short time painkiller need.