Outcome analysis of elderly patients undergoing laparoscopic resection rectopexy for rectal prolapse

Laubert, Tilman; Bader, Franz G.; Kleemann, Markus; Esnaashari, Hamed; Bouchard, R.; Hildebrand, P.; Schlöricke, Erik; Bruch, Hans–Peter; Roblick, Uwe J.

doi:10.1007/s00384-011-1395-1

Cited by 31 publications

(17 citation statements)

References 30 publications

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“…In our study, rates of constipation and incontinence were similar for the two procedures (although higher in the younger group), indicating that older patients can expect a good functional result, both short- and long-term [14, 15]. No formal instruments were employed, however, in trying to assess functional outcomes for younger and older patients, which could introduce recall and recording bias.…”

Section: Discussionmentioning

confidence: 67%

“…In the case of rectal prolapse, emphasis has been shifting towards the more durable abdominal approach with better functional outcomes compared to the ‘safer’ (although also with significant associated morbidity) perineal approach. This and other recent studies show that recent changes towards the abdominal approach, specifically laparoscopic rectopexy (with and without sigmoid resection), make it a safe and effective way to repair rectal prolapse in elderly patients [14, 15]. Although most of the studies to date report somewhat higher rates of post-operative complications in abdominal surgeries, the rates are low enough to justify a more aggressive abdominal approach to prolapse.…”

Section: Discussionmentioning

confidence: 86%

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Changing approaches to rectal prolapse repair in the elderly

Poylin

Bensley

Nagle

2013

Gastroenterology Report

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Aim: The abdominal approach to rectal prolapse is associated with lower rates of recurrence but a higher chance of complications and has been traditionally reserved for younger patients. However, longer life expectancy and wider use of laparoscopic techniques necessitates another look at the abdominal approach in older patients.Methods: This was a retrospective review of data from patients undergoing abdominal repair of rectal prolapse between 2005 and 2011.Results: Forty-six abdominal repairs (laparoscopic or open suture rectopexy, sigmoidectomy and rectopexy and low anterior resection) were performed during the study period. Twenty-nine repairs (63%) were performed in patients under the age of 70 (average age 51) and 17 (37%) in patients older than 70 (average age 76; range 71–89). Most of the cases performed during the initial 3 years of the study were via laparotomy. However, in the last 4 years, the laparoscopic approach was used in 83% of younger patients and 69% of older patients. Average length of stay was 2.6 days for younger and 3.8 days for older patients. Both groups had similar rates of re-admission: 20% vs 23%. The rate of wound infection was higher in the younger patients (5% vs nil). However, rates of urinary tract infection, two instances (10%) vs four (30%), urinary retention, one instance (5%) vs two (15.4%), ileus, one instance (5%) vs two (15.4%) were higher in the older group.Conclusion: Wider use of laparoscopy has precipitated a change in the approach to rectal prolapse in older patients. Although associated with a slightly higher rate of post-operative complications, the abdominal approach to rectal prolapse is feasible, safe and effective in patients older than 70 years.

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Section: Discussionmentioning

confidence: 67%

Section: Discussionmentioning

confidence: 86%

Changing approaches to rectal prolapse repair in the elderly

Poylin

Bensley

Nagle

2013

Gastroenterology Report

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“…Daten von Marusch et al [19] zeigen jedoch deutlich, dass die Lernkurve für laparoskopische Eingriffe weit über den vorgegebenen 20-30 Resektionen liegt. Darüber hinaus liegen die Konversionsraten an spezialisierten Zentren mit 4-8% weit unter den in den vorliegenden Arbeiten publizierten Raten [20,21,22]. Somit sollte die Qualität der laparoskopischen Chirurgie in den einzelnen Studien zumindest kritisch beleuchtet werden, obgleich sie wohl die praktische Realität in den 1990er-Jahren darstellten, in denen die meisten Patienten der betrachteten Studien operiert wurden.…”

Section: Diskussionunclassified

Minimalinvasive Chirurgie bei Malignomen des Gastrointestinaltrakts: Kolon - Pro-Position

Späth¹,

Müller²,

Nitsche³

et al. 2013

Visc Med

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Hintergrund: Laparoskopische Resektionen von Kolonkarzinomen werden in Deutschland immer häufiger durchgeführt. Dabei müssen sich die minimalinvasiven Verfahren an den onkologischen Ergebnissen der offenen Chirurgie messen, die bisher den Goldstandard darstellen. Die vorliegende Arbeit soll anhand der evidenzbasierten Literatur einen kritischen Überblick über die Kurz- und Langzeitergebnisse der laparoskopischen Kolonchirurgie geben und sie in Bezug zu den Ergebnissen der offenen Chirurgie setzen. Methoden: Die Grundlage dieser Übersichtsarbeit bilden die fünf größten prospektiv randomisierten Studien zum Vergleich laparoskopischer und offener Chirurgie beim Kolonkarzinom (ALCCaS, Barcelona Trial, CLASICC Trial, COLOR Study und COST Study) sowie die bisher größte und aktuellste Metaanalyse. Im Folgenden sollen die erwähnten Studien hinsichtlich der Kurzzeit- und Langzeitergebnisse kritisch zusammengefasst sowie die wichtigsten Endpunkte beleuchtet werden. Ergebnisse: Die laparoskopische Chirurgie des Kolonkarzinoms ist hinsichtlich der onkologischen Langzeitergebnisse der offenen Resektion zumindest gleichwertig. Vorteile bestehen in der frühen postoperativen Phase sowie im perioperativen Outcome. Die höheren direkten Kosten werden durch kürzere Liegezeiten, niedrigere Morbidität und weniger Re-Interventionen bezüglich Adhäsionen und Narbenhernien ausgeglichen. Schlussfolgerungen: Eine kritische und individuelle Indikationsstellung vorausgesetzt, sollte bei entsprechender Expertise und Erfahrung den laparoskopischen Verfahren zur Therapie des Kolonkarzinoms der Vorzug gegeben werden, um den Patienten bei gleichwertigen onkologischen Langzeitergebnissen die Vorteile der minimalinvasiven Chirurgie nicht vorzuenthalten.

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“…Incontinence and constipation improved in half of the patients irrespectively of age. 31 Dyrberg used a laparoscopic dorsal mesh rectopexy in 81 older patients with FRP.…”

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confidence: 99%

Surgical Approaches for Rectal Prolapse and their Comparative Study

Shaikh¹

2015

WJOLS

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Rectal prolapse is a distressing condition often affecting elderly patients. Open rectopexy has a proven track record in the treatment of this condition but may be complicated by significant morbidity. The benign nature of the disease and reduced pain and pulmonary complications of the laparoscopic approach makes this an attractive operation in this patient group. Laparoscopic prosthesis fixation rectopexy and lateral ligament suspension with and without colectomy have been described with low recurrence rates, good patient acceptability, symptom improvement, on both radiological and physiological assessments. Currently, the laparoscopic approach with ventral mesh rectopexy or resection rectopexy is the two most commonly used techniques. As high quality evidence is missing, an individualized approach is recommend for every patient considering age, individual health status and the underlying morphological and functional disorders.

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Outcome analysis of elderly patients undergoing laparoscopic resection rectopexy for rectal prolapse

Cited by 31 publications

References 30 publications

Changing approaches to rectal prolapse repair in the elderly

Changing approaches to rectal prolapse repair in the elderly

Minimalinvasive Chirurgie bei Malignomen des Gastrointestinaltrakts: Kolon - Pro-Position

Surgical Approaches for Rectal Prolapse and their Comparative Study

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