Laparoscopic ventral rectopexy in patients with fecal incontinence associated with rectoanal intussusception: prospective evaluation of clinical, physiological and morphological changes

Tsunoda, Akira; Takahashi, Tomoko; Hayashi, Kentarō; Yagi, Yuma; Kusanagi, Hiroshi

doi:10.1007/s10151-018-1811-4

Cited by 15 publications

(6 citation statements)

References 30 publications

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“…The procedure used for anorectal manometry and rectal sensation has been described in a previous study [16]. Anal pressure was measured with a catheter-tip pressure transducer.…”

Section: Physiological Assessmentmentioning

confidence: 99%

Transanal repair of rectocele: prospective assessment of functional outcome and quality of life

2019

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“…The procedure used for anorectal manometry and rectal sensation has been described in a previous study [16]. Anal pressure was measured with a catheter-tip pressure transducer.…”

Section: Physiological Assessmentmentioning

confidence: 99%

Transanal repair of rectocele: prospective assessment of functional outcome and quality of life

2019

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“…They found successful anatomical correction in all patients, although eight patients (30.8%) developed new‐onset recto‐rectal intussusception. A few years later, the same group reported that defaecography confirmed anatomical correction of IRP in all but one of the 34 patients 6 months after LVMR, and again 38% (13/34) of the patients developed new‐onset recto‐rectal intussusception [33]. In the present study, 15% (4/26) of the patients developed IRP again at 5‐year follow‐up (RVMR 14% and LVMR 17%), and MR defaecography revealed one IRP in a patient primarily operated on for ERP.…”

Section: Discussionmentioning

confidence: 99%

Restored pelvic anatomy is preserved after laparoscopic and robot‐assisted ventral rectopexy: MRI‐based 5‐year follow‐up of a randomized controlled trial

et al. 2020

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Aim Our aim was to compare the long-term anatomical outcomes between robot-assisted ventral mesh rectopexy (RVMR) and laparoscopic ventral mesh rectopexy (LVMR) for external or internal rectal prolapse. Method This study is a follow-up of a single-centre randomized controlled trial (RCT). Thirty patients were randomly allocated to RVMR (n = 16) or LVMR (n = 14). The primary end-point was maintenance of the restored pelvic anatomy 5 years after the operation, as assessed by magnetic resonance (MR) defaecography. Secondary outcome measures included the Pelvic Organ Prolapse Quantification (POP-Q) measures and functional results assessed using symptom questionnaires. Results Twenty-six patients (14 RVMR and 12 LVMR) completed the 5-year follow-up and were included in the study. The MRI results, POP-Q measurements and symptom-specific quality of life measures did not differ between the RVMR and LVMR groups. The MRI measurements of the total study population remained unchanged between 3 months and 5 years. In the Pelvic Floor Distress Inventory (PFDI-20), the RVMR group had lower symptom scores (mean 96.0, SD 70.7) than the LVMR group (mean 160.6, SD 58.9; P = 0.004). In the subscales of pelvic organ prolapse (POPDI-6) (mean 23.2, SD 24.3 vs mean 52.4, SD 22.4; P = 0.001) and the Colorectal-Anal Distress Inventory (CRADI-8) (mean 38.4, SD 23.3 vs mean 58.6, SD 25.4; P = 0.009), the patients in the RVMR group had significantly better outcomes. Conclusion After VMR, the corrected anatomy was preserved. There were no clinically significant differences in anatomical results between the RVMR and LVMR procedures 5 years after surgery based on MR defaecography. However, functional outcomes were better after RMVR.

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“…Over the last decade, LVMR has become an increasingly popular surgical option for patients with high-grade IRP associated with symptomatic presentation manifest as constipation or incontinence. Table 4 shows data of 12 previous studies published since 2010, 7 of which were prospective [ 17 , 21 , 52 – 56 ] and 5 retrospective [ 18 , 19 , 25 , 41 , 57 ] in design. Notable amongst these is the large retrospective cohort study of Consten, et al [ 18 ] which reported outcomes of LVMR in a cohort of 919 patients from 2 centers, with a medium-term follow-up (median, 34 months; range 4 months–12 years).…”

Section: Discussionmentioning

confidence: 99%

Stepped-wedge randomized controlled trial of laparoscopic ventral mesh rectopexy in adults with chronic constipation

et al. 2022

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Background The effectiveness of laparoscopic ventral mesh rectopexy (LVMR) in patients with defecatory disorders secondary to internal rectal prolapse is poorly evidenced. A UK-based multicenter randomized controlled trial was designed to determine the clinical efficacy of LVMR compared to controls at medium-term follow-up. Methods The randomized controlled trial was conducted from March 1, 2015 TO January 31, 2019. A stepped-wedge RCT design permitted observer-masked data comparisons between patients awaiting LVMR (controls) with those who had undergone surgery. Adult participants with radiologically confirmed IRP refractory to conservative treatment were randomized to three arms with different delays before surgery. Efficacy outcome data were collected at equally stepped time points (12, 24, 36, 48, 60, and 72 weeks). Clinical efficacy of LVMR compared to controls was defined as ≥ 1.0-point reduction in Patient Assessment of Constipation-Quality of Life and/or Symptoms (PAC-QOL and/or PAC-SYM) scores at 24 weeks. Secondary outcome measures included 14-day diary data, the Generalized Anxiety Disorder scale (GAD-7), the Patient Health Questionnaire-9 (PHQ-9), St Marks incontinence score, the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12), the chronic constipation Behavioral Response to Illness Questionnaire (CC-BRQ), and the Brief Illness Perception Questionnaire (BIPQ). Results Of a calculated sample size of 114, only 28 patients (100% female) were randomized from 6 institutions (due mainly to national pause on mesh-related surgery). Nine were assigned to the T0 arm, 10 to T12, and 9 to T24. There were no substantial differences in baseline characteristics between the three arms. Compared to baseline, significant reduction (improvement) in PAC-QOL and PAC-SYM scores were observed at 24 weeks post-surgery (– 1.09 [95% CI – 1.76, – 0.41], p = 0.0019, and – 0.92 [– 1.52, – 0.32], p = 0.0029, respectively) in the 19 patients available for analysis (9 were excluded for dropout [n = 2] or missing primary outcome [n = 7]). There was a clinically significant long-term reduction in PAC-QOL scores (− 1.38 [− 2.94, 0.19], p = 0.0840 at 72 weeks). Statistically significant improvements in PAC-SYM scores persisted to 72 weeks (− 1.51 [− 2.87, − 0.16], p = 0.0289). Compared to baseline, no differences were found in secondary outcomes, except for significant improvements at 24 and 48 weeks on CC-BRQ avoidance behavior (− 14.3 [95% CI − 23.3, − 5.4], and − 0.92 [− 1.52, − 0.32], respectively), CC-BRQ safety behavior (− 13.7 [95% CI − 20.5, − 7.0], and − 13.0 [− 19.8, − 6.1], respectively), and BIPQ negative perceptions (− 16.3 [95% CI − 23.5, − 9.0], and − 10.5 [− 17.9, − 3.2], respectively). Conclusions With the caveat of under-powering due to poor recruitment, the study presents the first randomized trial evidence of short-term benefit of LVMR for internal rectal prolapse. Trial registration ISRCTN Registry (ISRCTN11747152).

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Laparoscopic ventral rectopexy in patients with fecal incontinence associated with rectoanal intussusception: prospective evaluation of clinical, physiological and morphological changes

Abstract: LVR for RAI produced adequate improvement of FI, and successful anatomical correction of RAI was confirmed by postoperative proctography. Postoperative increase in the rectal volume may have a positive effect on continence.

Cited by 15 publications

References 30 publications

Transanal repair of rectocele: prospective assessment of functional outcome and quality of life

Transanal repair of rectocele: prospective assessment of functional outcome and quality of life

Restored pelvic anatomy is preserved after laparoscopic and robot‐assisted ventral rectopexy: MRI‐based 5‐year follow‐up of a randomized controlled trial

Stepped-wedge randomized controlled trial of laparoscopic ventral mesh rectopexy in adults with chronic constipation

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