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Laparoscopic ventral rectopexy in patients with fecal incontinence associated with rectoanal intussusception: prospective evaluation of clinical, physiological and morphological changes

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Abstract

Background

Physiological changes after laparoscopic ventral rectopexy (LVR) in patients with rectoanal intussusception (RAI) remain unclear. This study was undertaken to evaluate physiological and morphological changes after LVR for RAI, and to study clinical outcomes following LVR with special reference to fecal incontinence (FI).

Methods

The study was conducted on patients who had LVR for RAI between February 2012 and December 2016 at our institution Patients with RAI and FI were included in the study. Patients with RAI and obstructed defecation and those with RAI and neurologic FI were not included. The patients had anorectal manometry preoperatively, and 3, 6, and 12 months postoperatively. Defecography was performed before and 6 months after the procedure. FI was evaluated using the Fecal Incontinence Severity Index (FISI).

Results

There were 34 patients (median age 77 years (range 60–93) years). Thirty-two patients (94%) were female and the median number of vaginal deliveries was 2 (range 0–5). Neither maximum resting pressure nor maximum squeeze pressure increased postoperatively. There was an overall increase in both defecatory desire volume (median preoperative 75 ml vs. 90 ml at 12 months; p = 0.002) and maximum tolerated volume (median preoperative 145 ml vs.175 ml at 12 months; p = 0.002). Postoperatively, RAI was eliminated in all patients but one, although 13 had residual rectorectal intussusception found at defecography. There was an overall reduction in both rectocele size (median preop 29 mm vs. postop 10 mm; p = 0.008) and pelvic floor descent (median preop 26 mm vs. postop 20 mm; p = 0.005). Twelve months after surgery, a reduction of at least 50% was observed in the FISI score for 31 incontinent patients (91%).

Conclusions

LVR for RAI produced adequate improvement of FI, and successful anatomical correction of RAI was confirmed by postoperative proctography. Postoperative increase in the rectal volume may have a positive effect on continence.

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References

  1. Shorvon PJ, McHugh S, Diamant NE, Somers S, Stevenson GW (1989) Defecography in normal volunteers: results and implications. Gut 30:1737–1749

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  2. Mellgren A, Bremmer S, Johansson C, Dolk A, Udén R, Ahlbäck SO et al (1994) Defecography. Results of investigations in 2,816 patients. Dis Colon Rectum 37:1133–1141

    Article  PubMed  CAS  Google Scholar 

  3. Broden B, Snellman B (1968) Procidentia of the rectum studied with cineradiography. A contribution to the discussion of causative mechanism. Dis Colon Rectum 11:330–347

    Article  PubMed  CAS  Google Scholar 

  4. Wijffels NA, Jones OM, Cunningham C, Bemelman WA, Lindsey I (2013) What are the symptoms of internal rectal prolapse? Colorectal Dis 15:368–373

    Article  PubMed  CAS  Google Scholar 

  5. Slawik S, Soulsby R, Carter H, Payne H, Dixon AR (2008) Laparoscopic ventral rectopexy, posterior colporrhaphy and vaginal sacrocolpopexy for the treatment of recto-genital prolapse and mechanical outlet obstruction. Colorectal Dis 10:138–143

    PubMed  CAS  Google Scholar 

  6. Gosselink MP, Adusumilli S, Gorissen KJ, Fourie S, Tuynman JB, Jones OM et al (2013) Laparoscopic ventral rectopexy for fecal incontinence associated with high-grade internal rectal prolapse. Dis Colon Rectum 56:1409–1414

    Article  PubMed  Google Scholar 

  7. 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 

  8. Dippolito A, Esser S, Reed J 3rd (2005) Anterior modification of Delorme procedure provides equivalent results to Delorme procedure in treatment of rectal outlet obstruction. Curr Surg 62:609–612

    Article  PubMed  Google Scholar 

  9. Boccasanta P, Venturi M, Stuto A, Bottini C, Caviglia A, Carriero 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 

  10. D’Hoore A, Cadoni R, Penninckx F (2004) Long-term outcome of laparoscopic ventral rectopexy for total rectal prolapse. Br J Surg 91:1500–1505

    Article  PubMed  Google Scholar 

  11. Prasad ML, Pearl RK, Abcarian H, Orsay CP, Nelson RL (1986) Perineal proctectomy, posterior rectopexy, and postanal levator repair for the treatment of rectal prolapse. Dis Colon Rectum 29:547–552

    Article  PubMed  CAS  Google Scholar 

  12. Tsunoda A, Ohta T, Kiyasu Y, Kusanagi H (2015) Laparoscopic ventral rectopexy for rectoanal intussusception: postoperative evaluation with proctography. Dis Colon Rectum 58:449–456

    Article  PubMed  Google Scholar 

  13. Portier G, Kirzin S, Cabarrot P, Queralto M, Lazorthes F (2011) The effect of abdominal ventral rectopexy on faecal incontinence and constipation in patients with internal intra-anal rectal intussusception. Colorectal Dis 13:914–917

    Article  PubMed  CAS  Google Scholar 

  14. Delemarre JB, Gooszen HG, Kruyt RH, Soebhag R, Geesteranus AM (1991) The effect of posterior rectopexy on fecal continence. A prospective study. Dis Colon Rectum 34:311–316

    Article  PubMed  CAS  Google Scholar 

  15. Schultz I, Mellgren A, Dolk A, Johansson C, Holmström B (1996) Continence is improved after the Ripstein rectopexy. Different mechanisms in rectal prolapse and rectal intussusception? Dis Colon Rectum 39:300–306

    Article  PubMed  CAS  Google Scholar 

  16. Otto SD, Ritz JP, Gröne J, Buhr HJ, Kroesen AJ (2010) Abdominal resection rectopexy with an absorbable polyglactin mesh: prospective evaluation of morphological and functional changes with consecutive improvement of patient’s symptoms. World J Surg 34:2710–2716

    Article  PubMed  CAS  Google Scholar 

  17. Rockwood TH, Church JM, Fleshman JW, Kane RL, Mavrantonis C, Thorson AG et al (1999) Patient and surgeon ranking of the severity of symptoms associated with fecal incontinence: the fecal incontinence severity index. Dis Colon Rectum 42:1525–1532

    Article  PubMed  CAS  Google Scholar 

  18. Agachan F, Chen T, Pfeifer J, Reissman P, Wexner SD (1996) A constipation scoring system to simplify evaluation and management of constipated patients. Dis Colon Rectum 39:681–685

    Article  PubMed  CAS  Google Scholar 

  19. Tsunoda A, Takahashi T, Ohta T, Kusanagi H (2016) A novel technique of introducing the mesh at the distal dissection while performing laparoscopic ventral rectopexy. Colorectal Dis 18:O334–O336

    Article  PubMed  CAS  Google Scholar 

  20. Tsunoda A, Takahashi T, Ohta T, Fujii W, Kiyasu Y, Kusanagi H (2016) Anterior intussusception descent during defecation is correlated with the severity of fecal incontinence in patients with rectoanal intussusception. Tech Coloproctol 20:171–176

    Article  PubMed  CAS  Google Scholar 

  21. Bartram CI, Turnbull GK, Lennard-Jones JE (1988) Evacuation proctography: an investigation of rectal expulsion in 20 subjects without defecatory disturbance. Gastrointest Radiol 13:72–80

    Article  PubMed  CAS  Google Scholar 

  22. Farouk R, Duthie GS, Bartolo DC, MacGregor AB (1992) Restoration of continence following rectopexy for rectal prolapse and recovery of the internal anal sphincter electromyogram. Br J Surg 79:439–440

    Article  PubMed  CAS  Google Scholar 

  23. Wijffels NA, Angelucci G, Ashrafi A, Jones OM, Cunningham C, Lindsey I (2011) Rectal hyposensitivity is uncommon and unlikely to be the central cause of obstructed defecation in patients with high-grade internal rectal prolapse. Neurogastroenterol Motil 23:151–154

    Article  PubMed  CAS  Google Scholar 

  24. Collinson R, Cunningham C, D’Costa H, Lindsey I (2009) Rectal intussusception and unexplained faecal incontinence: findings of a proctographic study. Colorectal Dis 11:77–83

    Article  PubMed  CAS  Google Scholar 

  25. Hayden DM, Weiss EG (2011) Fecal incontinence: etiology, evaluation, and treatment. Clin Colon Rectal Surg 24:64–70

    Article  PubMed  PubMed Central  Google Scholar 

  26. Formijne Jonkers HA, Poierrie N, Draaisma WA, Broeders IA, Consten EC (2013) Laparoscopic ventral rectopexy for rectal prolapse and symptomatic rectocele: an analysis of 245 consecutive patients. Colorectal Dis 15:695–699

    Article  PubMed  CAS  Google Scholar 

  27. Prapasrivorakul S, Gosselink MP, Gorissen KJ, Fourie S, Hompes R, Jones OM et al (2015) Sacral neuromodulation for faecal incontinence: is the outcome compromised in patients with high-grade internal rectal prolapse? Int J Colorectal Dis 30:229–234

    Article  PubMed  Google Scholar 

  28. Madden MV, Kamm MA, Nicholls RJ, Santhanam AN, Cabot R, Speakman CT (1992) Abdominal rectopexy for complete prolapse: prospective study evaluating changes in symptoms and anorectal function. Dis Colon Rectum 35:48–55

    Article  PubMed  CAS  Google Scholar 

  29. Yoshioka K, Hyland G, Keighley MR (1989) Anorectal function after abdominal rectopexy: parameters of predictive value in identifying return of continence. Br J Surg 76:64–68

    Article  PubMed  CAS  Google Scholar 

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Acknowledgements

The authors would like to thank Dr. Yuko Tsunoda for the statistical analyses.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Kameda Medical Center, Kamogawa, Japan

    A. Tsunoda, T. Takahashi, K. Hayashi, Y. Yagi & H. Kusanagi

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  1. A. Tsunoda
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  2. T. Takahashi
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  3. K. Hayashi
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  4. Y. Yagi
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  5. H. Kusanagi
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Correspondence to A. Tsunoda.

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The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the Ethical Committee of Kameda Medical Center.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Tsunoda, A., Takahashi, T., Hayashi, K. et al. Laparoscopic ventral rectopexy in patients with fecal incontinence associated with rectoanal intussusception: prospective evaluation of clinical, physiological and morphological changes. Tech Coloproctol 22, 425–431 (2018). https://doi.org/10.1007/s10151-018-1811-4

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  • DOI: https://doi.org/10.1007/s10151-018-1811-4

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