Long-term outcome of laparoscopic ventral rectopexy for total rectal prolapse

D’Hoore, André; Cadoni, R; Penninckx, Freddy

doi:10.1002/bjs.4779

Cited by 446 publications

(348 citation statements)

References 35 publications

(34 reference statements)

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“…Because this technique limits the dissection and the subsequent risk of autonomic nerve damage, the functional outcome is improved with minimal long term morbidity and low rates of recurrence and the short term follow up results are very convincing [2,3].…”

Section: Introductionmentioning

confidence: 99%

Tiesiosios žarnos iškritimo chirurginis gydymas – vieno centro patirtis

Danys¹,

Kavaliauskaitė²,

Žalimas³

et al. 2016

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BackgroundNo consensus on the optimal procedure for repair of rectal prolapse (RP) exist. We present the results of our 10 year experience of Vilnius University Hospital Santariskiu Klinikos. Patients and methodsRetrospective review was performed of the patients, operated on for rectal prolapse between 2005 and 2016. Patients were divided into two groups -internal recal prolapse (IRP) and complete rectal prolapse (CRP). Perioperative data between two groups were analysed. Statistical data analysis was carried out using the SPSS 20.0 software. To assess the difference between rectal prolapse groups of statistical methods the χ 2 test was used. Data were considered statistically significant at p < 0.05. Results 89 patients between 2005 and 2016 underwent surgical treatment for rectal prolapse at our department. IRP group included 52 (58,4%), CRP -37 (41,6%) patients. The male/female ratio was 1/6,4, the mean age was 58,3±15,2 years. Defecography was performed for 29 (32,6%)patients in IRP group and for 12 (13,5%) -in CRP group (p<0,001). 7 (7,9%) patients in CRP group had previous surgical procedure for RP while in IRP group there were none (p=0,02). The most common management of IRP included 6 strategies (n=25, 67,5% of group); of CRP -3 different procedures (n=38, 73,1% of group) (p=0,003). Mean hospital stay in IRP group was significantly (p=0,014) longer (9,78±4,6 days) than in CRP group (7,58±3,7 days). Mortality rate was 0 %. Mean follow-up (14 patients) was 20,93±17,21 months. ConclusionThere is no evidence-based consensus regarding treatment of rectal prolapse. Management of IRP covered a more diverse range of surgical options, including of open approach. Thus, hospital stay was longer, but no mortality occurred. Further follow-up for evaluation of long-term outcome is necessary. Key words: rectal prolapse, rectopexy, resection, laparoscopy 153Surgery for rectal prolapse -a single centre experience Įvadas Dėl vienos tiesiosios žarnos iškritimo gydymo strategijos nesutariama. Mes apžvelgėme tiesiosios žarnos iškritimo gydymą Vilniaus universiteto ligoninėje Santariškių klinikose. Pacientai ir metodaiRetrospektyviai tirti pacientai, operuoti dėl tiesiosios žarnos iškritimo 2005-2016 metais. Pacientai suskirstyti į dvi grupesviso storio iškritimo (CRP) ir vidinio iškritimo (IRP). Buvo palyginti perioperaciniai grupių duomenys. Duomenys apdoroti statistinio duomenų paketo SPSS 20.0 versija. Skirtumas tarp grupių lygintas remiantis chi kvadrato testu, vertintas kaip reikš-mingas, jei p vertė buvo < 0,05. Rezultatai Minėtu laikotarpiu operuoti 89 pacientai. Dėl vidinio iškritimo -52 (58,4 %), dėl viso storio iškritimo -37 (41,6 %). Vyrų ir moterų santykis buvo 1/6,4, vidutinis amžius -58,3 ± 15,2 metų. Defekografija atlikta 29 (32,6 %) IRP grupės ir 12 (13,5 %) -CRP grupės pacientams (p < 0,001). Septyni (7,9 %) CRP grupės pacientai praeityje buvo operuoti dėl tiesiosios žarnos iškritmo, o IRP grupėje anksčiau operuotų pacientų nebuvo (p=0,02). IRP grupės pacientai buvo operuoti šešiais būdais, o CRP -trimis būd...

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Section: Introductionmentioning

confidence: 99%

Tiesiosios žarnos iškritimo chirurginis gydymas – vieno centro patirtis

Danys¹,

Kavaliauskaitė²,

Žalimas³

et al. 2016

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“…It has also been shown that procedures with preservation of the lateral ligaments and limited lateral and posterior rectal dissection, including the ''old'' Orr-Loygue operation, are associated with good functional outcomes, minimizing postoperative constipation and not increasing recurrence, both in overt rectal prolapse and in rectal intussusception [6]. Since laparoscopic ventral rectopexy (LVR) was introduced by D'Hoore et al in 2004 [7], several studies have been published confirming positive results in terms of constipation and fecal incontinence for both full rectal prolapse and rectoanal intussusception [5,8,9]. A limited rectal mobilization is performed only unilaterally reducing the risk of inferior hypogastric nerve injury and therefore leading to a lower incidence of postoperative constipation [7,9].…”

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confidence: 99%

“…Since laparoscopic ventral rectopexy (LVR) was introduced by D'Hoore et al in 2004 [7], several studies have been published confirming positive results in terms of constipation and fecal incontinence for both full rectal prolapse and rectoanal intussusception [5,8,9]. A limited rectal mobilization is performed only unilaterally reducing the risk of inferior hypogastric nerve injury and therefore leading to a lower incidence of postoperative constipation [7,9]. Recently, we described a modification of LVR involving mesh fixation to the sacral hollow instead of the sacral promontory with a favorably low risk of postoperative constipation and excellent functional results [10].…”

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confidence: 99%

Abdominal recto(colpo)pexy for rectal prolapse: is a new era coming?

Infantino

Lauretta

2013

Tech Coloproctol

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“…A classical posterior rectopexy, shown to denervate the autonomic supply of the rectum [1, 2], worsens constipation for 50% of patients and has been abandoned [3]. The novel nervesparing laparoscopic anterior or ventral rectopexy, which improves constipation in cased of external prolapse [4], may alter the way internal rectal prolapse is managed.Your recent publication describing 17 patients who underwent a laparoscopic ventral rectopexy for OD syndrome causes us concerns [5]. The indication for surgery is not made clear.…”

mentioning

confidence: 99%

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confidence: 99%

Laparoscopic ventral rectopexy for obstructed defecation syndrome

Wijffels¹,

Cunningham²,

Lindsey³

2008

Surg Endosc

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Surgery for obstructed defecation (OD) caused by internal rectal prolapse has suffered a bad reputation. A classical posterior rectopexy, shown to denervate the autonomic supply of the rectum [1, 2], worsens constipation for 50% of patients and has been abandoned [3]. The novel nervesparing laparoscopic anterior or ventral rectopexy, which improves constipation in cased of external prolapse [4], may alter the way internal rectal prolapse is managed.Your recent publication describing 17 patients who underwent a laparoscopic ventral rectopexy for OD syndrome causes us concerns [5]. The indication for surgery is not made clear. A variety of findings were shown by defecating proctography, including rectocoele and enterocoele, but only four patients had rectal intussusception. For most of the patients, the Longo OD syndrome score actually deteriorated and, inconceivably, the patients were happy with worse constipation postoperatively. The morbidity rate of almost 50%, including a rectal perforation, a small bowel perforation, a mesh infection and explantation, and a peripheral nerve injury, is unacceptable.In our experience, rectoanal intussusception or a highgrade internal rectal prolapse plays the central role in OD. When OD is managed by dedicated functional colorectal surgeons through a specialist pelvic floor clinic, with multidisciplinary review of clinical, radiologic, and physiologic consideration, and careful case selection, the outcomes of anterior rectopexy need not be so poor.In a similar 3-year period, we treated 75 patients with OD and high-grade (intra-anal) internal prolapse by laparoscopic anterior rectopexy, with 4% morbidity and 75% to 80% improvement in OD symptoms as well as significant reduction in median Wexner OD scores (13 to 4; p \ 0.0001) [6]. Very similar results have recently been published by Slawik [7]. If internal prolapse surgery is to reestablish its reputation, we must do better. References

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Long-term outcome of laparoscopic ventral rectopexy for total rectal prolapse

Abstract: Laparoscopic ventral rectopexy is an effective technique for the correction of rectal prolapse and appears to avoid severe postoperative constipation. The ventral position of the prosthesis may explain the beneficial effect on symptoms of obstructed defaecation.

Cited by 446 publications

References 35 publications

Tiesiosios žarnos iškritimo chirurginis gydymas – vieno centro patirtis

Tiesiosios žarnos iškritimo chirurginis gydymas – vieno centro patirtis

Abdominal recto(colpo)pexy for rectal prolapse: is a new era coming?

Laparoscopic ventral rectopexy for obstructed defecation syndrome

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