Laparoscopic ventral rectopexy in male patients with external rectal prolapse is associated with a high reoperation rate

Rautio, Tero; Mäkelä‐Kaikkonen, Johanna; Vaarala, Markku H.; Kairaluoma, Matti I.; Kössi, Jyrki; Carpelan-Holmström, Monika; Salmenkylä, Sinikka; Ohtonen, Pasi; Mäkelä, Jyrki

doi:10.1007/s10151-016-1528-1

Cited by 17 publications

(25 citation statements)

References 19 publications

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“…There were 38 studies reporting the outcome of the use of mesh with rectopexy [13‐51] and one study reporting the outcome of resection suture rectopexy [45]. It was not possible to estimate the effect from pooled data in GRADE evidence due to lack of a comparator in all studies and one non‐mesh study with 0% recurrence.…”

Section: Resultsmentioning

confidence: 99%

European Society of Coloproctology guidance on the use of mesh in the pelvis in colorectal surgery

et al. 2021

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Section: Resultsmentioning

confidence: 99%

European Society of Coloproctology guidance on the use of mesh in the pelvis in colorectal surgery

et al. 2021

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“…Inadequate anterior rectal dissection and inadequate fixation of the mesh to the anterior rectal wall or sacral promontory and the type of mesh used are some of the reported technical factors [8,15]. Furthermore, sex, BMI, and previous history of prolapse repair [9,11] have been suggested as the clinical factors. Nonetheless, these studies did not determine the risk factors for recurrence using multivariate analysis except that by Fu et al [9] who evaluated the factors contributing to recurrence in female patients using a Cox hazard regression model.…”

Section: Discussionmentioning

confidence: 99%

Predictive Factors for Recurrence of External Rectal Prolapse after Laparoscopic Ventral Rectopexy

Tsunoda

Takahashi

Matsuda

et al. 2021

J Anus Rectum Colon

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Objectives: This study aimed to evaluate factors that contribute to the recurrence of external rectal prolapse (ERP) following laparoscopic ventral rectopexy (LVR). Methods: All patients who underwent LVR using synthetic meshes between 2011 and 2018 were prospectively included. A standard questionnaire including the Fecal Incontinence Severity Index (FISI) and Constipation Scoring System (CSS) was administered preoperatively and postoperatively. Defecography was performed 6 months postoperatively. Univariate and backward stepwise multivariate Cox analysis was performed to determine the prognostic factors of recurrence. Results: In total, 132 patients with a median follow-up of 46 months were included. The overall recurrence rate was 6.8% (n = 9), as confirmed by defecography at 6 months in six of the patients. None of the patients developed mesh erosion. FISI and CSS scores were significantly reduced at 3 months and remained significantly reduced for 3 years. Multivariate analyses revealed that the predictors of recurrence included male sex (hazards ratio, 11.3; 95% confidence interval, 3.0-43.0) and age >80 years (hazards ratio, 10.7; 95% confidence interval, 1.3-86.3). Eight patients with recurrence underwent surgery via Delorme's procedure (n = 7) and posterior rectopexy (n = 1). Two patients with new-onset rectoanal intussusception and one with uncorrected sigmoidocoele underwent repeat LVR. Conclusions: LVR is effective in treating ERP with low morbidity and low recurrence. Male patients and patients older than 80 years are at increased risk of recurrence. Hence, the LVR technique should be modified or coupled with other perineal procedures when treating ERP, especially in male patients.

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“…Some technical aspects are emerging from the literature and deserve consideration; in a female patient, the deep anterior dissection of the rectum from the vagina does not carry particular risks. In a male however, the deep anterior dissection of the rectum from seminal vesicles and prostate may be more challenging and even if it seems to be safe in terms of incidence of postoperative complications such as sexual disturbances (impotence, retrograde ejaculation) [42], unwilling problems in a young patient, reoperation rate has been reported to be not negligible [43], with 33% further surgery either due to persistent or recurrent prolapse. Other concerns may arise as far as mesh use in rectal surgery and in fact a new type of postoperative morbidity has been observed in case of ventral mesh rectopexy, that is mesh erosion.…”

Section: Proctological Diseases In Surgical Practicementioning

confidence: 99%

Challenges in the Surgical Treatment of Rectal Prolapse

Pietroletti¹

2018

Proctological Diseases in Surgical Practice

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The approach to a patient with overt rectal prolapse remains controversial since the choice of the most appropriate technical option may be a difficult task. The different approaches are based upon patients' age, comorbidities, sex, size of prolapse, associated incontinence, constipation, and urinary and genital disturbances. However, analysis of the literature failed to detect a significant evidence favoring one among the large number of those different surgical techniques proposed for the treatment of rectal prolapse. In fact, many randomized prospective controlled trials, comparing perineal and abdominal operations, rectopexy alone, resection alone and/or resection plus rectopexy could not find significant differences in terms of morbidity, mortality, improvement of incontinence or constipation, quality of life and recurrence. Therefore, without a clear-cut support by the literature, a pragmatic approach is necessary, applying common sense, experience and considering the availability of resources as well. Nevertheless, we may expect that definitive answers to many open questions about surgery of rectal prolapse may come from larger studies and longer follow-up.

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Laparoscopic ventral rectopexy in male patients with external rectal prolapse is associated with a high reoperation rate

Cited by 17 publications

References 19 publications

European Society of Coloproctology guidance on the use of mesh in the pelvis in colorectal surgery

European Society of Coloproctology guidance on the use of mesh in the pelvis in colorectal surgery

Predictive Factors for Recurrence of External Rectal Prolapse after Laparoscopic Ventral Rectopexy

Challenges in the Surgical Treatment of Rectal Prolapse

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