Abstract
Rectoanal intussusception (RAI) treated using laparoscopic ventral rectopexy (LVR) may give rise to rectorectal intussusception (RRI) during defecation postoperatively. However, only a few studies have analyzed the results of LVR using pelvic floor imaging, which is important when interpreting postoperative symptoms in patients with RAI. Thus, this study was designed to find the preoperative variables that may help predict the postoperative occurrence of RRI and to determine whether RRI may have negative effects on bowel symptoms after LVR for RAI. Consecutive patients treated between 2012 and 2017 were included. Defecatory function was evaluated using the Constipation Scoring System (CSS) and the Fecal Incontinence Severity Index (FISI). Defecography was performed before and 6 months after LVR. Of the 66 patients with RAI preoperatively, 34 had mixed obstructed defecation (OD) and fecal incontinence (FI), 18 had OD alone, and 12 had FI alone. Twelve months after surgery, a reduction of at least 50% was observed in the CSS score of 25 patients (52%) with OD and in the FISI of 37 incontinent patients (87%). Postoperatively, RAI was replaced with RRI in 21 and posterior RAI in 2 patients. These anatomical changes were found in patients who had a greater anorectal angle at rest preoperatively. However, the improvement in bowel symptoms was unrelated to the anatomical changes. Improvement in bowel symptoms after LVR for RAI was unrelated to the postoperative occurrence of RRI or posterior RAI, which were found in patients who had a vertical rectum at rest preoperatively.
Similar content being viewed by others
References
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
Berman IR, Harris MS, Rabeler MB (1990) Delorme's transrectal excision for internal rectal prolapse. Patient selection, technique, and three-year follow-up. Dis Colon Rectum 33:573–580
Boccasanta P, Venturi M, Stuto A, Bottini C, Caviglia A, Carriero A, Mascagni D, Mauri R, Sofo L, Landolfi V (2004) Stapled transanal rectal resection for outlet obstruction: a prospective, multicenter trial. Dis Colon Rectum 47:1285–1296 discussion 1296-7
D'Hoore A, Cadoni R, Penninckx F (2004) Long-term outcome of laparoscopic ventral rectopexy for total rectal prolapse. Br J Surg 9:1500–1505
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
Emile SH, Elfeki HA, Youssef M, Farid M, Wexner SD (2017) Abdominal rectopexy for the treatment of internal rectal prolapse: a systematic review and meta-analysis. Color Dis 19:O13–O24
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
Shorvon PJ, McHugh S, Diamant NE, Somers S, Stevenson GW (1989) Defecography in normal volunteers: results and implications. Gut. 30:1737–1749
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
Rockwood TH, Church JM, Fleshman JW, Kane RL, Mavrantonis C, Thorson AG, Wexner SD, Bliss D, Lowry AC (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
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
Faccioli N, Comai A, Mainardi P, Perandini S, Moore F, Pozzi-Mucelli R (2010) Defecography: a practical approach. Diagn Interv Radiol. 16:209–216
Bartram CI, Turnbull GK, Lennard-Jones JE (1988) Evacuation proctography: an investigation of rectal expulsion in 20 subjectswithout defecatory disturbance. Gastrointest Radiol. 13:72–80
Hawkins AT, Olariu AG, Savitt LR, Gingipally S, Wakamatsu MM, Pulliam S, Weinstein MM, Bordeianou L (2016) Impact of rising grades of internal rectal intussusception on fecal continence and symptoms of constipation. Dis Colon Rectum 59:54–61
Collinson R, Cunningham C, D'Costa H, Lindsey I (2009) Rectal intussusception and unexplained faecal incontinence: findings of a proctographic study. Color Dis 11:77–83
Tsunoda A, Takahashi T, Hayashi K, Yagi Y, Kusanagi H (2018) 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
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
Rao SS (2003) Constipation: evaluation and treatment. Gastroenterol Clin N Am 32:659–683
Hayden DM, Weiss EG (2011) Fecal incontinence: etiology, evaluation, and treatment. Clin Colon Rectal Surg 24:64–70
Formijne Jonkers HA, Poierrié N, Draaisma WA, Broeders IA, Consten EC (2013) Laparoscopic ventral rectopexy for rectal prolapse and symptomatic rectocele: an analysis of 245 consecutive patients. Color Dis 15:695–699
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. Color Dis 10:138–143
Ris F, Gorissen KJ, Ragg J, Gosselink MP, Buchs NC, Hompes R, Cunningham C, Jones O, Slater A, Lindsey I (2017) Rectal axis and enterocele on proctogram may predict laparoscopic ventral mesh rectopexy outcomes for rectal intussusception. Tech Coloproctol 21:627–632
Acknowledgments
The authors thank S. Takada for his assistance with statistical analysis.
We would like to thank Editage (www.editage.jp) for English language editing.
Author information
Authors and Affiliations
Contributions
NO: conception and design of the study, acquisition, analysis and interpretation of data, writing the article. AT: conception and design of the study, acquisition and interpretation of data, writing the article. TT: analysis and interpretation of data, critical revision. SM: acquisition and interpretation of data, critical revision. HK: analysis and interpretation of data, critical revision.
Corresponding author
Ethics declarations
Conflict of Interest
The authors declare that they have no conflict of interest.
Ethical Approval
This study was approved by the Ethical Committee of Kameda Medical Center. (Approval number: 18–158).
Ethical Standards
All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.
Informed Consent
Informed consent was obtained from all patients by authors.
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
Oka, N., Tsunoda, A., Takahashi, T. et al. Predictive Factors and Effects of Replaced Rectorectal Intussusception on Functional Outcomes in Patients with Rectoanal Intussusception Who Have Undergone Laparoscopic Ventral Rectopexy. Indian J Surg 83, 79–86 (2021). https://doi.org/10.1007/s12262-020-02262-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12262-020-02262-3