Outcome of a Modified Laparoscopic Suture Rectopexy for Rectal Prolapse with the Use of a Single or Double Suture: A Case Series of 15 Patients

Abstract

Case seriesPatient: —Final Diagnosis: Rectal prolapseSymptoms: Bleeding per rectum • constipationMedication: —Clinical Procedure: Simple technique for rectopexySpecialty: SurgeryObjective:Unusual setting of medical careBackground:Surgery is considered to be a mainstay of therapy for full-thickness rectal prolapse (FTRP). Surgical procedures for FTRP have been described, but optimal treatment is still controversial. The aim of this report is to evaluate the safety and feasibility of a simplified laparoscopic suture rectopexy (LSR) in a case series of 15 patients who presented with FTRP and who had postoperative follow-up for six months.Case Reports:Fifteen patients who underwent a modified LSR at our surgical unit from September 2010 were retrospectively evaluated. The mean age of the patients was 72.5±10.9 years. All 15 patients underwent general anesthesia, with rectal mobilization performed according to the plane of the total mesorectal excision. By lifting the mobilized and dissected rectum cranially to the promontorium, the optimal point for subsequent suture fixation of the rectum was marked. The seromuscular layer of the anterior right wall was then sutured to the presacral fascia using only one or two interrupted nonabsorbable polypropylene sutures. The mean operative time was 176.2±35.2 minutes, with minimal blood loss. No moderate or severe postoperative complications were observed, and there was no postoperative mortality. One patient (6.7%) developed recurrence of rectal prolapse one month following surgery.Conclusions:The advantages of this LSR procedure for the management of patients with FTRP are its simplicity, safety, efficacy, and practicality and the potential for its use in patients who can tolerate general anesthesia.

Suture rectopexy versus ventral mesh rectopexy for complete full-thickness rectal prolapse and intussusception: systematic review and meta-analysis

“…In the SR group, 14 studies reported data on constipation, two of which found a statistically significant postoperative improvement. Nine further studies 18 , 25 , 31 , 34 , 42 , 44 , 51 , 52 , 56 did not report statistical significance testing, but suggested an improvement in constipation. One study showed a significant worsening of constipation after SR.…”

Laparoscopic Sutureless Rectopexy Using a Fixation Device for Complete Rectal Prolapse

“…The procedure requires neither mesh fixation nor resection of the sigmoid colon, and it is, therefore, safe with low morbidity and mortality rates. Compared with findings in previous reports, the operative duration was <3 hours which was acceptable 18. While complete division of the lateral ligaments of the rectum was associated with a reduced recurrence rate, it also caused an increased rate of postoperative constipation.…”

“…Compared with findings in previous reports, the operative duration was <3 hours which was acceptable. 18 While complete division of the lateral ligaments of the rectum was associated with a reduced recurrence rate, it also caused an increased rate of postoperative constipation. Reportedly, 50% and 15% of patients with and without preoperative constipation, respectively, worsened after suture rectopexy.…”

“…17 The recurrence rate seen with the abdominal suture rectopexy is 0% to 12.5%. 2,18 In the Ripstein procedure (anterior sling rectopexy, introduced in 1965), the rectum was mobilized and pulled out and sutured to the sacrum, using a 4 to 5 cm wide mesh to affix the rectal wall to the presacral fascia. The recurrence rate for this procedure is reportedly 0% to 13%.…”

“…There is a severe risk of anastomotic leakage due to intestinal resection and anastomosis and postoperative mortality may be higher than that associated with other procedures 17. The recurrence rate seen with the abdominal suture rectopexy is 0% to 12.5% 2,18…”