Treatment of recurrent rectal prolapse after a laparoscopic ventral mesh rectopexy

Brown, S. R.; Pearson, K.; Hainsworth, A.; Williams, A.

doi:10.1007/s10151-022-02689-8

Cited by 5 publications

(5 citation statements)

References 8 publications

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“…Indeed, the major series report recurrence rates ranging from 0 to 14%, but there is wide variability in the definition and follow-up duration [2,[4][5][6][7]. It seems that after long-term follow-up, the recurrence rate is closer to 20-30% following rectal prolapse surgery [22]. In our series, we defined recurrence as the presence of a persistent posterior pelvic floor disorder, symptomatic or not; stage ≥ II rectocele; or externalized rectal prolapse.…”

Section: Discussionmentioning

confidence: 96%

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Moving from Laparoscopic Synthetic Mesh to Robotic Biological Mesh for Ventral Rectopexy: Results from a Case Series

Drissi,

Rogier-Mouzelas,

Fernandez Arias

et al. 2023

JCM

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Introduction: Laparoscopic ventral mesh rectopexy (VMR) is the standard procedure for the treatment of posterior pelvic organ prolapse. Despite significant functional improvement and anatomical corrections, severe complications related to mesh augmentation can occur in a few proportions of patients. In order to decrease the number of rare but severe complications, we developed a variant of the conventional VMR without any rectal fixation and using a robotic approach with biological mesh. The aim of this study was to compare the results of laparoscopic ventral rectopexy with synthetic mesh (LVMRS) to those of robotic ventral rectopexy with biological mesh (RVMRB). Methods: Between 2004 and 2021, patients operated on for VMR in our unit were identified and separated into two groups: LVMRS and RVMRB. The surgical technique for both groups consisted of VMR without any rectal fixation, with mesh distally secured on the levator ani muscles. Results: 269 patients with a mean age of 62 years were operated for posterior pelvic floor disorder: rectocele (61.7%) and external rectal prolapse (34.6%). 222 (82.5%) patients received LVMRS (2004–2015), whereas 47 were operated with RVMRB (2015–2021). Both groups slightly differed for combined anterior fixation proportion (LVMRS 39% vs. RVMRB 6.4%, p < 0.001). Despite these differences, the length of stay was shorter in the RVMRB group (2 vs. 3 days, p < 0.001). Postoperative complications were comparable in the two groups (1.8 vs. 4.3%, p = 0.089) and mainly consisted of minor complications. Functional outcomes were favorable and similar in both groups, with an improvement in bulging, obstructed defecation symptoms, and fecal incontinence (NS in subgroup analysis). In the long term, there were no mesh erosions reported. The overall recurrence rate was 11.9%, and was comparable in the two groups (13% LVMRS vs. 8.5, p = 0.43). Conclusions: VMR without rectal fixation is a safe and effective approach in posterior organ prolapse management. RVMRB provides comparable results in terms of recurrence and functional results, with avoidance of unabsorbable material implantation.

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Section: Discussionmentioning

confidence: 96%

“…A recurrence was observed in 32 (11.9%) patients at a median term of 14 [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] months. The mean age in this subgroup of patients was 62.5 ± 16 years.…”

Section: Recurrencementioning

confidence: 99%

Moving from Laparoscopic Synthetic Mesh to Robotic Biological Mesh for Ventral Rectopexy: Results from a Case Series

Drissi,

Rogier-Mouzelas,

Fernandez Arias

et al. 2023

JCM

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“…These findings are consistent with another study [ 42 ]. The observed improvement in ODS symptoms after LVMR can be attributed to the autonomic nerve-sparing surgical technique [ 9 ]. Furthermore, this procedure facilitates the restoration of rectal anatomy, enhanced physiological function of the rectum, restored sensitivity to feces, and improved FI symptoms [ 43 ].…”

Section: Discussionmentioning

confidence: 99%

“…Laparoscopic approaches offer cost reduction owing to shorter hospital stays, faster patient recovery, and decreased morbidity [ 8 ]. Laparoscopic ventral mesh rectopexy (LVMR) is an autonomic nerve-sparing technique that has gained popularity owing to its favorable postoperative functional outcomes, low recurrence rate, and low morbidity [ 9 , 10 ]. Advancements in laparoscopy and general anesthesia have expanded the application of abdominal rectopexy to include elderly patients [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Comparative study of laparoscopic ventral mesh rectopexy versus perineal stapler resection for external full-thickness rectal prolapse in elderly patients: enhanced outcomes and reduced recurrence rates—a retrospective cohort study

Habeeb,

Podda,

Chiaretti

et al. 2024

Tech Coloproctol

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Background In elderly patients with external full-thickness rectal prolapse (EFTRP), the exact differences in postoperative recurrence and functional outcomes between laparoscopic ventral mesh rectopexy (LVMR) and perineal stapler resection (PSR) have not yet been investigated. Methods We conducted a retrospective multicenter study on 330 elderly patients divided into LVMR group (n = 250) and PSR (n = 80) from April 2012 to April 2019. Patients were evaluated before and after surgery by Wexner incontinence scale, Altomare constipation scale, and patient satisfaction questionnaire. The primary outcomes were incidence and risk factors for EFTRP recurrence. Secondary outcomes were postoperative incontinence, constipation, and patient satisfaction. Results LVMR was associated with fewer postoperative complications (p < 0.001), lower prolapse recurrence (p < 0.001), lower Wexner incontinence score (p = 0.03), and lower Altomare’s score (p = 0.047). Furthermore, LVMR demonstrated a significantly higher surgery–recurrence interval (p < 0.001), incontinence improvement (p = 0.019), and patient satisfaction (p < 0.001) than PSR. Three and 13 patients developed new symptoms in LVMR and PSR, respectively. The predictors for prolapse recurrence were LVMR (associated with 93% risk reduction of recurrence, OR 0.067, 95% CI 0.03–0.347, p = 0.001), symptom duration (prolonged duration was associated with an increased risk of recurrence, OR 1.131, 95% CI 1.036–1.236, p = 0.006), and length of prolapse (increased length was associated with a high recurrence risk (OR = 1.407, 95% CI = 1.197–1.655, p < 0.001). Conclusions LVMR is safe for EFTRP treatment in elderly patients with low recurrence, and improved postoperative functional outcomes. Trial registration Clinical Trial.gov (NCT05915936), retrospectively registered on June 14, 2023.

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“…In the adult population, the peak incidence occurs in the fifth decade and is more common in women (80-90%) (Madbouly & Mohii, 2019;Rao & Tetangco, 2020). In RP, an impaired adaptation of the rectum to stretching can contribute to anal incontinence, and more than half of patients have concomitant urinary incontinence (Alkatrani & Basrah, 2021;Brown et al, 2022;D'Hoore, 2022). Constipation is associated with prolapse in 15-65% of patients (Alwahid et al, 2019), excessive stress can lead to a strengthening of the anterior wall of the upper part of the rectum into the anal canal (Alwahid et al, 2019), possibly causing a solitary ulcer due to chronic mucosal trauma (Pescatori et al, 1998).…”

Section: Introductionmentioning

confidence: 99%

Comparative Study of Surgical Treatment with Abdominal and Perineal Approaches in Patients with Rectal Prolapse

Imanova¹

2022

J Biochem Technol

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The article presents a comparative study of the results of surgical treatment with abdominal and perineal approaches in patients with rectal prolapse. In 83 patients of both sexes (52 women) aged 16-85 years (median in women 46.5 ± 1.1, in men 48.2 ± 1.7 years) with rectal prolapse, abdominal or perineal fixation surgeries with and without resection of the prolapsed part of the rectum and minimally invasive surgeries were performed. After the abdominal or perineal procedures, including minimally invasive procedures, stable and successful results were obtained in 80 patients (96.4%). Recurrences occurred only in 2 cases, and mortality in 1 case. Local complications developed in the form of wound infection (6), and feeling of a foreign body during mesh rectopexy (3); general complications included sepsis (1) and constipation (3). No major complications were requiring repeated surgery. In rectal prolapse surgery, abdominal procedures are ideal for young patients, and perineal procedures are ideal for elderly and senile patients with severe concomitant pathology. Suture rectopexy is characterized by adequate treatment, while mesh rectopexy is not superior to suture rectopexy. However, meshes as a foreign body increase the risk of local infection. Both rectopexy options are popular with many surgeons and the choice depends on the experience and preference of the surgeon. Laparoscopic rectopexy has results that are equivalent to or better than open pexy. It is preferred because it is simple and easy to perform. The results of perianal rectosigmoidectomy are much better than Delorme procedures, especially when the posterior levatoroplasty is added to it.

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Treatment of recurrent rectal prolapse after a laparoscopic ventral mesh rectopexy

Cited by 5 publications

References 8 publications

Moving from Laparoscopic Synthetic Mesh to Robotic Biological Mesh for Ventral Rectopexy: Results from a Case Series

Moving from Laparoscopic Synthetic Mesh to Robotic Biological Mesh for Ventral Rectopexy: Results from a Case Series

Comparative study of laparoscopic ventral mesh rectopexy versus perineal stapler resection for external full-thickness rectal prolapse in elderly patients: enhanced outcomes and reduced recurrence rates—a retrospective cohort study

Comparative Study of Surgical Treatment with Abdominal and Perineal Approaches in Patients with Rectal Prolapse

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