Abstract
Background
The aim of this study was to assess the long-term outcomes of laparoscopic rectopexy for full-thickness rectal prolapse (FTRP).
Methods
Data of a prospectively maintained database were analysed. A structured telephone interview was conducted to assess a consecutive series of long-term outcomes of an unselected population who had laparoscopic rectopexy at a single centre between April 2006 and April 2014. The primary outcome was recurrence of FTRP. Secondary outcomes were functional outcomes and morbidity associated with the procedure.
Results
A total of 80 patients (74 female, median age of 66 years, range 23–96 years) underwent a laparoscopic rectopexy, of whom 35 (44%) were for recurrent prolapse. Seventy-two patients (90%) had a posterior suture rectopexy, six (8%) had a ventral mesh rectopexy, one (1%) had a combination of both procedures, and one (1%) had a posterior suture rectopexy with a sacrocolpopexy. There was no conversion to open surgery. Three patients (4%) needed reoperation within 30 days after surgery: two due to small bowel obstruction and one for a suspected port site hernia. Seventy-four patients (93%) were available for either clinical follow-up (FU) or telephone interview and there were 17 (23%) recurrences of FTRP at the median FU of 57 months (range 1–121 months). The median time to recurrence was 12 months (range 1–103 months). Recurrence of FTRP was seen in nine patients (12%) within 1 year following surgery. A history of multiple previous prolapse repairs increased the risk of prolapse recurrence (odds ratio 8.33, 95% confidence interval 1.38–50.47, p = 0.020). Based on clinical follow-up of 71 patients up to 1 year, there were 41 patients (58%) who had faecal incontinence prior to rectopexy of whom two patients (5%) had complete resolution of symptoms and 14 (34%) had improvement.
Conclusions
Laparoscopic rectopexy is a safe operation for full-thickness rectal prolapse. The durability of the repair diminished over time, particularly for patients operated on for recurrent prolapse.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Bordeianou L, Hicks CW, Kaiser AM, Alavi K, Sudan R, Wise PE (2014) Rectal prolapse: an overview of clinical features, diagnosis, and patient-specific management strategies. J Gastrointest Surg Off J Soc Surg Aliment Tract 18(5):1059–1069. https://doi.org/10.1007/s11605-013-2427-7
Kim DS, Tsang CB, Wong WD, Lowry AC, Goldberg SM, Madoff RD (1999) Complete rectal prolapse: evolution of management and results. Dis Colon Rectum 42(4):460–466 (discussion 466–469)
Riansuwan W, Hull TL, Bast J, Hammel JP, Church JM (2010) Comparison of perineal operations with abdominal operations for full-thickness rectal prolapse. World J Surg 34(5):1116–1122. https://doi.org/10.1007/s00268-010-0429-0
Mollen RM, Kuijpers JH, van Hoek F (2000) Effects of rectal mobilization and lateral ligaments division on colonic and anorectal function. Dis Colon Rectum 43(9):1283–1287
Gunner CK, Senapati A, Northover JM, Brown SR (2016) Life after PROSPER. What do people do for external rectal prolapse? Colorectal Dis Off J Assoc Coloproctol G B Irel 18(8):811–814. https://doi.org/10.1111/codi.13255
Tsunoda A, Takahashi T, Ohta T, Kusanagi H (2016) Quality of life after laparoscopic ventral rectopexy. Colorectal Dis Off J Assoc Coloproctol G B Irel 18(8):O301–O310. https://doi.org/10.1111/codi.13247
Boons P, Collinson R, Cunningham C, Lindsey I (2010) Laparoscopic ventral rectopexy for external rectal prolapse improves constipation and avoids de novo constipation. Colorectal Dis Off J Assoc Coloproctol G B Irel 12(6):526–532. https://doi.org/10.1111/j.1463-1318.2009.01859.x
Lechaux D, Trebuchet G, Siproudhis L, Campion JP (2005) Laparoscopic rectopexy for full-thickness rectal prolapse: a single-institution retrospective study evaluating surgical outcome. Surg Endosc 19(4):514–518. https://doi.org/10.1007/s00464-004-9088-2
Consten EC, van Iersel JJ, Verheijen PM, Broeders IA, Wolthuis AM, D’Hoore A (2015) Long-term outcome after laparoscopic ventral mesh rectopexy: an observational study of 919 consecutive patients. Ann Surg 262(5):742–747. https://doi.org/10.1097/sla.0000000000001401 (discussion 747–748)
Foppa C, Martinek L, Arnaud JP, Bergamaschi R (2014) Ten-year follow up after laparoscopic suture rectopexy for full-thickness rectal prolapse. Colorectal Dis Off J Assoc Coloproctol G B Irel 16(10):809–814. https://doi.org/10.1111/codi.12689
D’Hoore A, Cadoni R, Penninckx F (2004) Long-term outcome of laparoscopic ventral rectopexy for total rectal prolapse. Br J Surg 91(11):1500–1505. https://doi.org/10.1002/bjs.4779
McCulloch P, Altman DG, Campbell WB, Flum DR, Glasziou P, Marshall JC, Nicholl J, Aronson JK, Barkun JS, Blazeby JM, Boutron IC, Campbell WB, Clavien PA, Cook JA, Ergina PL, Feldman LS, Flum DR, Maddern GJ, Nicholl J, Reeves BC, Seiler CM, Strasberg SM, Meakins JL, Ashby D, Black N, Bunker J, Burton M, Campbell M, Chalkidou K, Chalmers I, de Leval M, Deeks J, Ergina PL, Grant A, Gray M, Greenhalgh R, Jenicek M, Kehoe S, Lilford R, Littlejohns P, Loke Y, Madhock R, McPherson K, Meakins J, Rothwell P, Summerskill B, Taggart D, Tekkis P, Thompson M, Treasure T, Trohler U, Vandenbroucke J (2009) No surgical innovation without evaluation: the IDEAL recommendations. Lancet 374(9695):1105–1112. https://doi.org/10.1016/s0140-6736(09)61116-8
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213
Kennedy RH, Francis EA, Wharton R, Blazeby JM, Quirke P, West NP, Dutton SJ (2014) Multicenter randomized controlled trial of conventional versus laparoscopic surgery for colorectal cancer within an enhanced recovery programme: EnROL. J Clin Oncol Off J Am Soc Clin Oncol 32(17):1804–1811. https://doi.org/10.1200/jco.2013.54.3694
D’Hoore A, Penninckx F (2006) Laparoscopic ventral recto(colpo)pexy for rectal prolapse: surgical technique and outcome for 109 patients. Surg Endosc 20(12):1919–1923. https://doi.org/10.1007/s00464-005-0485-y
Senapati A, Gray RG, Middleton LJ, Harding J, Hills RK, Armitage NC, Buckley L, Northover JM (2013) PROSPER: a randomised comparison of surgical treatments for rectal prolapse. Colorectal Dis Off J Assoc Coloproctol G B Irel 15(7):858–868. https://doi.org/10.1111/codi.12177
Bishawi M, Foppa C, Tou S, Bergamaschi R (2016) Recurrence of rectal prolapse following rectopexy: a pooled analysis of 532 patients. Colorectal Dis Off J Assoc Coloproctol G B Irel 18(8):779–784. https://doi.org/10.1111/codi.13160
Lundby L, Iversen LH, Buntzen S, Wara P, Hoyer K, Laurberg S (2016) Bowel function after laparoscopic posterior sutured rectopexy versus ventral mesh rectopexy for rectal prolapse: a double-blind, randomised single-centre study. Lancet Gastroenterol Hepatol 1(4):291–297. https://doi.org/10.1016/s2468-1253(16)30085-1
Fu CW, Stevenson AR (2017) Risk factors for recurrence after laparoscopic ventral rectopexy. Dis Colon Rectum 60(2):178–186. https://doi.org/10.1097/dcr.0000000000000710
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval
This study was completed as a service audit, approved by the Research and Development Department of the London North West Hospitals NHS Trust.
Informed consent
For this service audit, formal consent is not required in the United Kingdom.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
de Bruijn, H., Maeda, Y., Tan, KN. et al. Long-term outcome of laparoscopic rectopexy for full-thickness rectal prolapse. Tech Coloproctol 23, 25–31 (2019). https://doi.org/10.1007/s10151-018-1913-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10151-018-1913-z