Safety of Laparoscopic Ventral Rectopexy in the Elderly

Gültekin, Fatma Ayça; Wong, Marcus; Podevin, J.; Barussaud, Marie-Line; Boutami, Myriam; Lehur, P.‐A.; Meurette, G.

doi:10.1097/dcr.0000000000000308

Cited by 32 publications

(11 citation statements)

References 20 publications

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“…LVMR is now accepted as safe procedure that can effectively address the symptoms of rectal prolapse and obstructive defecation. There are evidence to support the view that LVMR is safe in the elderly [15] and can be performed safely in the emergency setting. Symptoms improvement needs to be assessed objectively using validated symptoms questionnaires preoperatively as well as during follow up [16].…”

Section: Discussionmentioning

confidence: 73%

Safety and Efficacy of Laparoscopic Ventral Mesh Rectopexy and Sacrocolpopexy for Rectal Prolapse and Obstructed Defecation: Analysis of First 20 Cases at a UK District General Hospital

Tennakoon¹,

Farook²

2016

Surgery

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Journal of Surgery IntroductionLaparoscopic ventral mesh rectopexy (LVMR) is gaining wider acceptance amongst colorectal surgeons as the technique that can address symptoms of both external and internal rectal prolapse. It also allows correction of any associated rectocele, enterocele and posterior vaginal wall prolapse as well as vault prolapse. The learning curve for LVMR is unknown and there is no consensus on case selection. The aim of this study is to share our results to show that LVMR can be learnt and safely performed by experienced laparoscopic colorectal surgeons in district general hospitals with short term results similar to that of establish centres. MethodologyPrior to start of this retrospective study UK National Health Service Health Research Authority website was consulted and NHS Research Ethics Committee approval was not required. The procedures followed were in accordance with the principles of the Helsinki Declaration of 1975, as revised in 2000.Laparoscopic Ventral Mesh Rectopexy was started at our institution in January 2011. All patients presented with obstructed defecation syndrome (ODS) and rectal prolapse from January 2011 to January 2015 are included in this analysis. Patients presenting to the out patients department with symptoms of difficulty in evacuation, sense of incomplete evacuation, pelleted stools, frequent visits to the toilet, perineal, vaginal or anal digitation, incontinence and pelvic pain were clinically diagnosed as having obstructed defecation. All with such symptoms were investigated with anorectal physiology, defecation proctography, colon transit studies, colonoscopy or sigmoidoscopy as appropriate. Patients with obvious rectal prolapse underwent either colonoscopy or sigmoidoscopy as indicated.Fluoroscopic defecography was performed with vaginal, oral and bladder contrast. Defecography, anorectal physiology and symptoms were discussed in the fortnightly pelvic floor MDT which consists of two colorectal surgeons (both authors), one radiologist, the radiographer who performs defecography, one urogynaecologist and the colorectal nurse specialist who performs anorectal physiology and biofeedback. Fluoroscopy films were reviewed by all MDT members and intussusception was graded according to oxford prolapse grade [1] (Grade 1-High recto rectal intussusception, Grade 2-Low recto-rectal intussusception, Grade 3-High recto-anal intussusception, Grade 4-Low recto-anal intussusception, Grade 5-Complete rectal prolapse). Evacuation time, number of attempts at evacuation and speed of opening of the anal canal were considered as subjective global markers of evacuation efficiency. In the case of rectocele barium trapping in the rectocele was considered significant. All patients with ODS then underwent maximal medical therapy as well as biofeedback. Since 2012 patients are offered trans anal irrigation as a form of conservative treatment if they do not respond to maximal medical therapy. Patients with high grade intussusception (Grade 3 and 4) and reduced AbstractIntroduction: ...

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Section: Discussionmentioning

confidence: 73%

Safety and Efficacy of Laparoscopic Ventral Mesh Rectopexy and Sacrocolpopexy for Rectal Prolapse and Obstructed Defecation: Analysis of First 20 Cases at a UK District General Hospital

Tennakoon¹,

Farook²

2016

Surgery

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“…[17][18][19] In the older group, patients with high ASA scores (≥3 score, 2.9% vs. 36.4%, p=0.005) were prominent. Sphincter-preserving surgery such as lower anterior resection and intersphincteric resection was done in the younger group more frequently than the older group (77.2% vs. 45.5%, p=0.065).…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Surgery for Rectal Cancer after Preoperative Chemoradiation in Elderly Patients

Choi

Lee

et al. 2017

J Minim Invasive Surg

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Purpose: Laparoscopic surgery has been accepted as a standard procedure for colorectal cancer.Preoperative chemoradiation for rectal cancer has some advantages, such as decreased tumor size and lower stage, and lower local recurrence. However, preoperative chemoradiation has the disadvantage of increasing postoperative complication risks. The aim of this study was to evaluate the safety of laparoscopic surgery for rectal cancer after preoperative chemoradiation in elderly patients.Methods: 46 patients underwent laparoscopic surgery for rectal cancer after preoperative chemoradiation. Patients were divided into younger (<70 years, n=35) and older groups (≥70 years, n=11). Results:In the younger group, men were more predominant (80% vs. 54.5%, p=0.124). In the older group, more patients had high American Society of Anesthesiologists scores (score 3 was 2.9% vs. 36.4%, p=0.005) than in the younger group. Sphincter-preserving surgery was performed more frequently in the younger group (77.2% vs. 45.5%, p=0.065). Operation time (195.8 min. vs. 212.5 min, p=0.553) and intraoperative blood loss (200.6 cc vs. 209.1 cc, p=0.952) were not significantly different. Significant anastomotic leakage was absent in both groups. Postoperative hospital stay was 9.7 and 10.9 days (p=0.669). Complete remission rates were similar in the both groups (8.8% vs. 18.2%, p=0.824). Conclusion:Postoperative outcomes are comparable between older group and younger group.Laparoscopic surgery could be considered as safe, feasible therapeutic options in elderly patients after preoperative chemoradiation for rectal cancer. However, large randomized trials with comparative methodologies are needed.

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“…laparoscopic promonto-fixation [11]. Studies where outcomes could not be segregated by eligible procedure were also excluded due to a mixed patient population with internal and external rectal prolapse [12][13][14][15][16][17][18][19], mixed indications including numerous pelvic floor abnormalities [20] or limited postoperative outcomes [21].…”

Section: Scopementioning

confidence: 99%

“…These ligaments contain nerves to the rectal wall and the resultant denervation may be the cause. In the process of developing alternative resuspending procedures, surgeons have attempted to limit the effect of the foreign material by using sutures only [5], added a resection of the sigmoid colon to the rectopexy [6][7][8] or more recently, limiting the dissection of the rectum to the ventral surface by supporting the rectum with mesh [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23]. In addition, laparoscopy has become the favoured approach procedurally, not only allowing a more rapid recovery but also easing access to, and visibility in the pelvis.…”

Section: Introduction Background and Procedural Variationsmentioning

confidence: 99%

Surgery for constipation: systematic review and practice recommendations

et al. 2017

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Safety of Laparoscopic Ventral Rectopexy in the Elderly

Abstract: Laparoscopic ventral rectopexy appears to be safe in select elderly patients.

Cited by 32 publications

References 20 publications

Safety and Efficacy of Laparoscopic Ventral Mesh Rectopexy and Sacrocolpopexy for Rectal Prolapse and Obstructed Defecation: Analysis of First 20 Cases at a UK District General Hospital

Safety and Efficacy of Laparoscopic Ventral Mesh Rectopexy and Sacrocolpopexy for Rectal Prolapse and Obstructed Defecation: Analysis of First 20 Cases at a UK District General Hospital

Laparoscopic Surgery for Rectal Cancer after Preoperative Chemoradiation in Elderly Patients

Surgery for constipation: systematic review and practice recommendations

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