Purpose: Although numerous procedures have been proposed for the treatment of patients with a rectal prolapse, the most effective operation has not yet been established. Minimal rectal mobilization can prevent constipation; however, it is associated with increased recurrence rates. We describe our novel method for a laparoscopic posterolateral rectopexy, which includes rectal mobilization with a posterior-right unilateral dissection, suture fixation to the sacral promontory with a polypropylene mesh (Optilene), and a mesorectal fascia propria that is as wide as possible. The present report describes our novel method and assesses the short-term outcomes of patients.
Methods: Between June 2014 and June 2017, 63 patients (28 males and 35 females) with a full-thickness rectal prolapse underwent a laparoscopic posterolateral (LPL) rectopexy. We retrospectively analyzed the clinical characteristics and postoperative complications in those patients. The outcome of surgery was determined by evaluating the answers on fecal incontinence questionnaires, the results of anal manometry preoperatively and 3 months postoperatively, the patients' satisfaction scores (0-10), and the occurrence of constipation.
Results: No recurrence was reported during follow-up (3.26 months), and 3 patients reported postoperative complications (wound infection, postoperative sepsis, which was successfully treated with conservative management, and retrograde ejaculation). Compared to the preoperative baseline, fecal incontinence at three months postoperatively showed an overall improvement. The mean patient satisfaction score was 9.55 ± 0.10, and 8 patients complained of persistent constipation.
Conclusion: LPL rectopexy is a safe, effective method showing good functional outcomes by providing firm, solid fixation for patients with a full-thickness rectal prolapse.
Keywords: Constipation; Posterior mesh rectopexy; Rectal prolapse.
Conflict of interest statement
No potential conflict of interest relevant to this article was reported.
Laparoscopic Ventral Rectopexy, Posterior Colporrhaphy and Vaginal Sacrocolpopexy for the Treatment of Recto-Genital Prolapse and Mechanical Outlet ObstructionS Slawik et al. Colorectal Dis 10 (2), 138-43. PMID 17498206.Laparoscopic ventral rectopexy is safe with relatively low morbidity. In the medium-term, it provides good results for prolapse and associated symptoms of incontinence an …
Laparoscopic Ventral Rectopexy for External Rectal Prolapse Improves Constipation and Avoids De Novo ConstipationP Boons et al. Colorectal Dis 12 (6), 526-32. PMID 19486104.
Ventral rectopexy has a recurrent prolapse rate of < 5%, similar to that of posterior rectopexy. Its correction of preoperative constipation and avoidance of de novo c…
Ten-year Follow Up After Laparoscopic Suture Rectopexy for Full-Thickness Rectal ProlapseC Foppa et al. Colorectal Dis 16 (10), 809-14. PMID 24945584.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. …
Focus on Abdominal Rectopexy for Full-Thickness Rectal Prolapse: Meta-Analysis of LiteratureF Cadeddu et al. Tech Coloproctol 16 (1), 37-53. PMID 22170252. - ReviewLaparoscopic abdominal rectopexy is a safe and feasible procedure, which may compare equally with the open technique with regard to recurrence, incontinence and constipat …
Current Status of Laparoscopic and Robotic Ventral Mesh Rectopexy for External and Internal Rectal ProlapseJJ van Iersel et al. World J Gastroenterol 22 (21), 4977-87. PMID 27275090. - ReviewExternal and internal rectal prolapse with their affiliated rectocele and enterocele, are associated with debilitating symptoms such as obstructed defecation, pelvic pain …
- Bordeianou L, Hicks CW, Kaiser AM, Alavi K, Sudan R, Wise PE. Rectal prolapse: an overview of clinical features, diagnosis, and patient-specific management strategies. J Gastrointest Surg. 2014;18:1059–69. - PubMed
- D’Hoore A, Cadoni R, Penninckx F. Long-term outcome of laparoscopic ventral rectopexy for total rectal prolapse. Br J Surg. 2004;91:1500–5. - PubMed
- Formijne Jonkers HA, Poierrie N, Draaisma WA, Broeders IA, Consten EC. Laparoscopic ventral rectopexy for rectal prolapse and symptomatic rectocele: an analysis of 245 consecutive patients. Colorectal Dis. 2013;15:695–9. - PubMed
- Mercer-Jones MA, D’Hoore A, Dixon AR, Lehur P, Lindsey I, Mellgren A, et al. Consensus on ventral rectopexy: report of a panel of experts. Colorectal Dis. 2014;16:82–8. - PubMed