Laparoscopic Rectopexy for Rectal Prolapse to Reduce Surgical-Site Infections and Length of Stay
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Rectal prolapse is commonly seen in patients with significant co-morbidities. Multiple approaches have been described, including the use of laparoscopy. The purpose of this study was to determine if laparoscopic approaches for repair of rectal prolapse are associated with less short-term morbidity than open approaches.
The American College of Surgeons National Surgical Quality Improvement Program database was queried for patients who underwent laparoscopic or open rectopexy (R) or sigmoid resection and rectopexy (SR + R) between 2005 and 2008. Co-morbidities analyzed included diabetes, body mass index, chronic obstructive pulmonary disease, hypertension, cardiac (history of congestive heart failure, myocardial infarction, peripheral vascular disease, previous percutaneous cardiac intervention or surgery), and neurologic disorder (history of transient ischemic attack or cerebrovascular accident). Postoperative complications analyzed included surgical-site infections (SSIs), pneumonia, reintubation, pulmonary embolus, stroke, myocardial infarction, and sepsis. The χ 2 or t test/ANOVA were used to assess significance for categoric and continuous variables, respectively. Logistic regression analysis was used to determine risk factors for morbidity after rectal prolapse repair.
Altogether, 685 patients underwent surgical treatment of rectal prolapse. Most patients underwent open SR + R (open: 247 SR + R, 193 R; laparoscopic: 161 SR + R, 84 R). All patients had similar co-morbidity profiles. Patients undergoing laparoscopic R were significantly older (mean age 61.4 years) than those in the other three groups (p = 0.04). Operating time ranged from 128 min (open R) to 185 min (laparoscopic SR + R; p < 0.001). Open SR + R and open R were associated with significantly more morbidity than laparoscopic SR + R and R [odds ratio (OR) 0.42, 95 % confidence interval (CI) 0.22–0.83, p = 0.01]. Comparing all four procedures, there was a trend to decreased overall morbidity with laparoscopic R, but without statistical significance (OR 0.31, 95 % CI 0.07–1.40, p = 0.13). Length of hospital stay (LOS) and SSI rates were significantly lower with laparoscopic R than with the other three procedures.
Patients who undergo laparoscopic rectopexy have a shorter LOS and lower SSI rate than patients who undergo other abdominal procedures for repair of rectal prolapse. Further study is necessary to determine the long-term outcomes from laparoscopic rectopexy, but in high-risk patients the laparoscopic approach can decrease perioperative risk.
- Madoff RD, Williams JG, Wong WD et al (1992) Long-term functional results of colon resection and rectopexy for overt rectal prolapse. Am J Gastroenterol 87:101–104
- Oliver GC, Vachon D, Eisenstat TE et al (1994) Delorme’s procedure for complete rectal prolapse in severely debilitated patients: an analysis of 41 cases. Dis Colon Rectum 37:461–467 CrossRef
- Kim DS, Tsang CB, Wong WD, et al (1999) Complete rectal prolapse: evolution of management and results. Dis Colon Rectum 42:460–466; discussion 466–469
- Steele SR, Goetz LH, Minami S et al (2006) Management of recurrent rectal prolapse: surgical approach influences outcome. Dis Colon Rectum 49:440–445 CrossRef
- Carpelan-Holmstrom M, Kruuna O, Scheinin T (2006) Laparoscopic rectal prolapse surgery combined with short hospital stay is safe in elderly and debilitated patients. Surg Endosc 20:1353–1359 CrossRef
- Deen KI, Grant E, Billingham C et al (1994) Abdominal resection rectopexy with pelvic floor repair versus perineal rectosigmoidectomy and pelvic floor repair for full-thickness rectal prolapse. Br J Surg 81:302–304 CrossRef
- Penninckx F, D’Hoore A, Sohier S et al (1997) Abdominal resection rectopexy versus Delorme’s procedure for rectal prolapse: a predictable outcome. Int J Colorectal Dis 12:49–50 CrossRef
- Hoel AT, Skarstein A, Ovrebo KK (2009) Prolapse of the rectum, long-term results of surgical treatment. Int J Colorectal Dis 24:201–207 CrossRef
- Solomon MJ, Young CJ, Eyers AA et al (2002) Randomized clinical trial of laparoscopic versus open abdominal rectopexy for rectal prolapse. Br J Surg 89:35–39 CrossRef
- Demirbas S, Akin ML, Kalemoglu M et al (2005) Comparison of laparoscopic and open surgery for total rectal prolapse. Surg Today 35:446–452 CrossRef
- Kairaluoma MV, Viljakka MT, Kellokumpu IH (2003) Open vs. laparoscopic surgery for rectal prolapse: a case-controlled study assessing short-term outcome. Dis Colon Rectum 46:353–360 CrossRef
- Raftopoulos Y, Senagore AJ, Di Giuro G et al (2005) Recurrence rates after abdominal surgery for complete rectal prolapse: a multicenter pooled analysis of 643 individual patient data. Dis Colon Rectum 48:1200–1206 CrossRef
- Tou S, Brown SR, Malik AI et al (2008) Surgery for complete rectal prolapse in adults. Cochrane Database Syst Rev 4(CD001758):1
- Byrne CM, Smith SR, Solomon MJ et al (2008) Long-term functional outcomes after laparoscopic and open rectopexy for the treatment of rectal prolapse. Dis Colon Rectum 51:1597–1604 CrossRef
- Sajid MS, Siddiqui MR, Baig MK (2010) Open vs laparoscopic repair of full-thickness rectal prolapse: a re-meta-analysis. Colorectal Dis 12:515–525 CrossRef
- 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 CrossRef
- Baker R, Senagore AJ, Luchtefeld MA (1995) Laparoscopic-assisted vs. open resection: rectopexy offers excellent results. Dis Colon Rectum 38:199–201 CrossRef
- Xynos E, Chrysos E, Tsiaoussis J et al (1999) Resection rectopexy for rectal prolapse: the laparoscopic approach. Surg Endosc 13:862–864 CrossRef
- Rose J, Schneider C, Scheidbach H et al (2002) Laparoscopic treatment of rectal prolapse: experience gained in a prospective multicenter study. Langenbecks Arch Surg 387:130–137 CrossRef
- Laparoscopic Rectopexy for Rectal Prolapse to Reduce Surgical-Site Infections and Length of Stay
World Journal of Surgery
Volume 37, Issue 5 , pp 1110-1114
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