Skip to main content

Advertisement

SpringerLink
Log in

Obstructive defecation syndrome: 19 years of experience with laparoscopic resection rectopexy

  • Original Article
  • Published:
Techniques in Coloproctology Aims and scope Submit manuscript

Abstract

Background

In obstructive defecation syndrome (ODS) combinations of morphologic alterations of the pelvic floor and the colorectum are nearly always evident. Laparoscopic resection rectopexy (LRR) aims at restoring physiological function. We present the results of 19 years of experience with this procedure in patients with ODS.

Methods

Between 1993 and 2012, 264 patients underwent LRR for ODS at our department. Perioperative and follow-up data were analyzed.

Results

The female/male ratio was 25.4:1, mean age was 61.3 years (±14.3 years), and mean body mass index (BMI) was 25.2 kg/m2 (±4.2 kg/m2). The pathological conditions most frequently found in combination were a sigmoidocele plus a rectocele (n = 79) and a sigmoidocele plus a rectal prolapse or intussusception (n = 69). The conversion rate was 2.3 % (n = 6). The mortality rate was 0.75 % (n = 2), the rate of complications requiring surgical re-intervention was 4.3 % (n = 11), and the rate of minor complications was 19.8 % (n = 51). Follow-up data were available for 161 patients with a mean follow-up of 58.2 months (±47.1 months). Long-term results showed that 79.5 % of patients (n = 128) reported at least an improvement of symptoms. In cases of a sigmoidocele (n = 63 available for follow-up) or a rectal prolapse II°/III° (n = 72 available for follow-up), the improvement rates were 79.4 % (n = 50) and 81.9 % (n = 59), respectively.

Conclusions

LRR is a safe and effective procedure. Our perioperative results and long-term functional outcome strengthen the evidence regarding benefits of LRR in patients with an outlet obstruction. However, careful patient selection is essential.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Suares NC, Ford AC (2011) Prevalence of, and risk factors for, chronic idiopathic constipation in the community: systematic review and meta-analysis. Am J Gastroenterol 106:1582–1591

    Article  PubMed  Google Scholar 

  2. Sonnenberg A, Koch TR (1989) Epidemiology of constipation in the United States. Dis Colon Rectum 32:1–8

    Article  PubMed  CAS  Google Scholar 

  3. Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC (2006) Functional bowel disorders. Gastroenterology 130:1480–1491

    Article  PubMed  Google Scholar 

  4. Schiedeck TH, Schwandner O, Scheele J, Farke S, Bruch HP (2005) Rectal prolapse: which surgical option is appropriate? Langenbecks Arch Surg 390:8–14

    Article  PubMed  CAS  Google Scholar 

  5. Ommer A, Rolfs T, Walz MK (2010) Chirurgische Therapieoptionen bie Stuhlentleerungsstörungen. CHAZ 11:393–404

    Google Scholar 

  6. Lehur PA, Stuto A, Fantoli M et al (2008) Outcomes of stapled transanal rectal resection vs. biofeedback for the treatment of outlet obstruction associated with rectal intussusception and rectocele: a multicenter, randomized, controlled trial. Dis Colon Rectum 5:1611–1618

    Article  Google Scholar 

  7. Gervaz P, Inan I, Perneger T, Schiffer E, Morel P (2010) A prospective, randomized, single-blind comparison of laparoscopic versus open sigmoid colectomy for diverticulitis. Ann Surg 252:3–8

    Article  PubMed  Google Scholar 

  8. Samaranayake CB, Luo C, Plank AW, Merrie AE, Plank LD, Bissett IP (2010) Systematic review on ventral rectopexy for rectal prolapse and intussusception. Colorectal Dis 12:504–512

    Article  PubMed  CAS  Google Scholar 

  9. Tou S, Brown SR, Malik AI, Nelson RL (2008) Surgery for complete rectal prolapse in adults. Cochrane Database Syst Rev (4):CD001758. doi:10.1002/14651858.CD001758.pub2

  10. Madiba TE, Baig MK, Wexner SD (2005) Surgical management of rectal prolapse. Arch Surg 140:63–73

    Article  PubMed  Google Scholar 

  11. Matzel KE, Heuer S, Zhang W (2008) Rectal prolapse. Abdominal or local approach. Chirurg 79:444–451

    Article  PubMed  CAS  Google Scholar 

  12. Laubert T, Bader FG, Kleemann M et al. (2012) Outcome analysis of elderly patients undergoing laparoscopic resection rectopexy for rectal prolapse. Int J Colorectal Dis. doi:10.1007/s00384-011-1395-1

  13. Ng SS, Leung KL, Lee JF, Yiu RY, Li JC, Hon SS (2009) Long-term morbidity and oncologic outcomes of laparoscopic-assisted anterior resection for upper rectal cancer: ten-year results of a prospective, randomized trial. Dis Colon Rectum 52:558–566

    Article  PubMed  Google Scholar 

  14. Ashari LH, Lumley JW, Stevenson AR, Stitz RW (2005) Laparoscopically-assisted resection rectopexy for rectal prolapse: ten years’ experience. Dis Colon Rectum 48:982–987

    Article  PubMed  Google Scholar 

  15. Johnson E, Stangeland A, Johannessen HO, Carlsen E (2007) Resection rectopexy for external rectal prolapse reduces constipation and anal incontinence. Scand J Surg 96:56–61

    PubMed  CAS  Google Scholar 

  16. von Papen M, Ashari LH, Lumley JW, Stevenson AR, Stitz RW (2007) Functional results of laparoscopic resection rectopexy for symptomatic rectal intussusception. Dis Colon Rectum 50:50–55

    Article  Google Scholar 

  17. Kariv Y, Delaney CP, Casillas S et al (2006) Long-term outcome after laparoscopic and open surgery for rectal prolapse: a case-control study. Surg Endosc 20:35–42

    Article  PubMed  CAS  Google Scholar 

  18. Jorge JM, Yang YK, Wexner SD (1994) Incidence and clinical significance of sigmoidoceles as determined by a new classification system. Dis Colon Rectum 37:1112–1117

    Article  PubMed  CAS  Google Scholar 

  19. Bruch HP, Herold A, Schiedeck T, Schwandner O (1999) Laparoscopic surgery for rectal prolapse and outlet obstruction. Dis Colon Rectum 42:1189–1194

    Article  PubMed  CAS  Google Scholar 

  20. Laubert T, Kleemann M, Schorcht A et al (2010) Laparoscopic resection rectopexy for rectal prolapse: a single-center study during 16 years. Surg Endosc 24:2401–2406

    Article  PubMed  Google Scholar 

  21. Roblick UJ, Bader FG, Jungbluth T, Laubert T, Bruch HP (2011) How to do it-laparoscopic resection rectopexy. Langenbecks Arch Surg 396:851–855

    Article  PubMed  Google Scholar 

  22. Pescatori M, Spyrou M, Pulvirenti d’Urso A (2006) A prospective evaluation of occult disorders in obstructed defecation using the ‘iceberg diagram’. Colorectal Dis 8:785–789

    Article  PubMed  CAS  Google Scholar 

  23. Bruch H-P, Fischer F, Schiedeck TH, Schwandner O (2004) Defäkationsobstruktion. Chirurg 75:861–870

    Article  PubMed  Google Scholar 

  24. Schwandner O, Farke S, Fischer F, Schiedeck TH, Bruch HP (2004) Chirurgische Therapie der Outlet-Obstrudkion bei Sigmoidozelen - Ist die lapaorskopische Operation sicher und komplikationsarm? Coloproctology 26:75–84

    Article  Google Scholar 

  25. Thompson JR, Chen AH, Pettit PD, Bridges MD (2002) Incidence of occult rectal prolapse in patients with clinical rectoceles and defecatory dysfunction. Am J Obstet Gynecol 187:1494–1499

    Article  PubMed  Google Scholar 

  26. Dodi G, Pietroletti R, Milito G, Binda G, Pescatori M (2003) Bleeding, incontinence, pain and constipation after STARR transanal double stapling rectotomy for obstructed defecation. Tech Coloproctol 7:148–153

    Article  PubMed  CAS  Google Scholar 

  27. Boccasanta P, Venturi M, Stuto A et al (2004) Stapled transanal rectal resection for outlet obstruction: a prospective, multicenter trial. Dis Colon Rectum 47:1285–1296

    Article  PubMed  Google Scholar 

  28. Madbouly KM, Abbas KS, Hussein AM (2010) Disappointing long-term outcomes after stapled transanal rectal resection for obstructed defecation. World J Surg 34:2191–2196

    Article  PubMed  Google Scholar 

  29. Zbar AP, Lienemann A, Fritsch H, Beer-Gabel M, Pescatori M (2003) Rectocele: pathogenesis and surgical management. Int J Colorectal Dis 18:369–384

    Article  PubMed  CAS  Google Scholar 

  30. Vermeulen J, Lange JF, Sikkenk AC, van der Harst E (2005) Anterolateral rectopexy for correction of rectoceles leads to good anatomical but poor functional results. Tech Coloproctol 9:35–41

    Article  PubMed  CAS  Google Scholar 

  31. Kim M, Reibetanz J, Boenicke L, Germer CT, Jayne D, Isbert C (2012) Quality of life after laparoscopic resection rectopexy. Int J Colorectal Dis 27:489–495

    Article  PubMed  Google Scholar 

  32. Orrom WJ, Bartolo DC, Miller R, Mortensen NJ, Roe AM (1991) Rectopexy is an ineffective treatment for obstructed defecation. Dis Colon Rectum 34:41–46

    Article  PubMed  CAS  Google Scholar 

  33. D’Hoore A, Vanbeckevoort D, Penninckx F (2008) Clinical, physiological and radiological assessment of rectovaginal septum reinforcement with mesh for complex rectocele. Br J Surg 95:1264–1272

    Article  PubMed  Google Scholar 

  34. Oom DM, Gosselink MP, van Wijk JJ, van Dijl VR, Schouten WR (2008) Rectocele repair by anterolateral rectopexy: long-term functional outcome. Colorectal Dis 10:925–930

    Article  PubMed  CAS  Google Scholar 

  35. Schultz I, Mellgren A, Dolk A, Johansson C, Holmstrom B (2000) Long-term results and functional outcome after Ripstein rectopexy. Dis Colon Rectum 43:35–43

    Article  PubMed  CAS  Google Scholar 

  36. Marchal F, Bresler L, Ayav A et al (2005) Long-term results of Delorme’s procedure and Orr-Loygue rectopexy to treat complete rectal prolapse. Dis Colon Rectum 48:1785–1790

    Article  PubMed  Google Scholar 

  37. Portier G, Iovino F, Lazorthes F (2006) Surgery for rectal prolapse: Orr-Loygue ventral rectopexy with limited dissection prevents postoperative-induced constipation without increasing recurrence. Dis Colon Rectum 49:1136–1140

    Article  PubMed  Google Scholar 

  38. Gemsenjager E (1996) Internal rectal prolapse: therapy outcome and current status. Schweiz Med Wochenschr German 126:1377–1384

    CAS  Google Scholar 

  39. Kellokumpu IH, Vironen J, Scheinin T (2000) Laparoscopic repair of rectal prolapse: a prospective study evaluating surgical outcome and changes in symptoms and bowel function. Surg Endosc 14:634–640

    Article  PubMed  CAS  Google Scholar 

  40. Tsiaoussis J, Chrysos E, Athanasakis E et al (2005) Rectoanal intussusception: presentation of the disorder and late results of resection rectopexy. Dis Colon Rectum 48:838–844

    Article  PubMed  Google Scholar 

  41. Benoist S, Taffinder N, Gould S, Chang A, Darzi A (2001) Functional results two years after laparoscopic rectopexy. Am J Surg 182:168–173

    Article  PubMed  CAS  Google Scholar 

  42. Vignali A, Di Palo S, Tamburini A, Radaelli G, Orsenigo E, Staudacher C (2005) Laparoscopic vs. open colectomies in octogenarians: a case-matched control study. Dis Colon Rectum 48:2070–2075

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

Mrs. C. Killaitis is gratefully acknowledged for keeping the database updated and for performing the statistical calculations.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Surgery, University Hospital Schleswig–Holstein Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany

    T. Laubert, M. Kleemann, U. J. Roblick, C. Bürk, P. Hildebrand, J. Lewejohann, E. Schlöricke & H.-P. Bruch

Authors
  1. T. Laubert
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Kleemann
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. U. J. Roblick
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. C. Bürk
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. P. Hildebrand
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J. Lewejohann
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. E. Schlöricke
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. H.-P. Bruch
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to T. Laubert.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Laubert, T., Kleemann, M., Roblick, U.J. et al. Obstructive defecation syndrome: 19 years of experience with laparoscopic resection rectopexy. Tech Coloproctol 17, 307–314 (2013). https://doi.org/10.1007/s10151-012-0925-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10151-012-0925-3

Keywords

Search

Navigation