Advertisement

Surgical Endoscopy

, Volume 25, Issue 8, pp 2699–2702 | Cite as

Outcome of laparoscopic rectopexy versus perineal rectosigmoidectomy for full-thickness rectal prolapse in elderly patients

  • Seung-Hyun Lee
  • Paryush Lakhtaria
  • Jorge Canedo
  • Yoon-Suk Lee
  • Steven D. WexnerEmail author
Article

Abstract

Background

The balance between abdominal and perineal approaches for rectal prolapse is always the higher morbidity but better outcome in the former setting. Therefore, perineal approaches have been preferred for the treatment of full-thickness rectal prolapse (FTRP) in elderly patients. However, laparoscopic rectopexy with or without resection also may be used for elderly patients and may confer the same benefits.

Purpose

The objective of this study was to evaluate safety and efficacy of laparoscopic rectopexy compared with perineal rectosigmoidectomy for FTRP in elderly patients.

Methods

Between July 2000 and June 2009, eight consecutive patients (8 women; mean age, 71 (range, 65–77) years) with FTRP underwent laparoscopic rectopexy (LAP group). During the same period, 143 patients underwent perineal rectosigmoidectomy (PRS group). A total of 123 patients were selected who underwent perineal rectosigmoidectomy (117 women; mean age, 80.7 (range, 66–98) years).

Results

Three patients (37.5%) in the LAP group and 29 patients (23.6%) in the PRS group had undergone previous operations for rectal prolapse. The mean follow-up periods were 6.9 months and 12.8 months, respectively. In the LAP group, operative time was longer (166.5 vs. 73.5 minutes; p > 0.05) and bleeding loss was more (101.7 vs. 31.6; p < 0.05), whereas the length of hospitalization was same between the two groups (5.4 vs. 5.3 days; p > 0.05). Postoperative complications included an incisional hernia in the LAP group (12.5%) and urinary retention (4.8%), anastomotic disruption (2.4%), urinary tract infection (1.6%), and atelectasis (1.6%) in the PRS group (13.8%). Recurrences were 1 (12.5%) in the LAP group and 14 (11.4%) in the PRS group.

Conclusions

Laparoscopic rectopexy is a safe and feasible procedure in elderly patients with FTRP but results in increased operative time.

Keywords

Colorectal  Laparoscopic rectopexy Rectal prolapse Perineal rectosigmoidectomy Elderly Altemeier procedure 

Notes

Disclosures

Steven D. Wexner is a consultant for Covidien and for Karl Storz Endoscopy. He is also entitled to receive inventors income from Karl Storz Endoscopy. Drs. Seung-Hyun Lee, Paryush Lakhtaria, Jorge Canedo, and Yoon-Suk Lee, have no conflicts of interest or financial ties to disclose.

References

  1. 1.
    Aitola PT, Hiltunen KM, Matikainen MJ (1992) Functional results of operative treatment of rectal prolapse over an 11-year period: emphasis on transabdominal approach. Dis Colon Rectum 42:655–660CrossRefGoogle Scholar
  2. 2.
    Deen KI, Grant E, Billingham C, Keighley MR (1994) Abdominal resection rectopexy with pelvic floor repair versus perineal rectosigmoidectomy and pelvic floor repair for full-thickness rectal prolapse. Br J Surg 81:302–304PubMedCrossRefGoogle Scholar
  3. 3.
    Kim DS, Tsang CB, Wong WD, Lowry AC, Goldberg SM, Madoff RD (1999) Complete rectal prolapse: evolution of management and results. Dis Colon Rectum 42:460–469PubMedCrossRefGoogle Scholar
  4. 4.
    Madiba TE, Baig MK, Wexner SD (2005) Surgical management of rectal prolapse. Arch Surg 140:63–73PubMedCrossRefGoogle Scholar
  5. 5.
    Altemeier WA, Gulbertson WR, Schowengerdt C, Hunt J (1971) Nineteen years’ experience with one-stage perineal repair rectal prolapse. Ann Surg 173:993–1006PubMedCrossRefGoogle Scholar
  6. 6.
    Zbar AP, Takashima S, Hasegawa T, Kitabayashi K (2002) Perineal rectosigmoidectomy (Altemeier’s procedure): a review of physiology technique and outcome. Tech Coloproctol 2:106–116Google Scholar
  7. 7.
    Baker R, Senagore AJ, Luchtefeld MA (1995) Laparoscopic-assisted vs. open resection. Rectopexy offers excellent results. Dis Colon Rectum 38:199–201PubMedCrossRefGoogle Scholar
  8. 8.
    Solomon MJ, Young CJ, Eyers AA, Roberts RA (2002) Randomized clinical trial of laparoscopic vs. open abdominal rectopexy for rectal prolapse. Br J Surg 89:35–39PubMedCrossRefGoogle Scholar
  9. 9.
    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 46:353–360PubMedCrossRefGoogle Scholar
  10. 10.
    Kariv Y, Delaney CP, Casillas S, Hammel J, Nocero J, Bast J, Brady K, Fazio VW, Senogore AJ (2006) Long-term outcome after laparoscopic and open surgery for rectal prolapse. Surg Endosc 20:35–42PubMedCrossRefGoogle Scholar
  11. 11.
    Frasson M, Braga M, Vignali A, Auliani W, Di Carlo V (2008) Benefits of laparoscopic colorectal resection are more pronounced in elderly patients. Dis Colon Rectum 51:296–300PubMedCrossRefGoogle Scholar
  12. 12.
    Person B, Cera SM, Sands DR, Weiss EG, Vernava AM, Nogueras JJ, Wexner SD (2008) Do elderly patients benefit from laparoscopic colorectal surgery? Surg Endosc 22:401–405PubMedCrossRefGoogle Scholar
  13. 13.
    Kaiwa Y, Kurokawa Y, Namiki K, Myojin T, Ansai M, Satomi S (2004) Outcome of laparoscopic rectopexy for complete rectal prolapse in patients older than 70 years versus younger patients. Surg Today 34:742–746PubMedCrossRefGoogle Scholar
  14. 14.
    Byrne CM, Smith SR, Solomon MJ, Young JM, Eyers AA, Young CJ (2008) Long-term functional outcomes after laparoscopic and open rectopexy for the treatment of rectal prolapse. Dis Colon Rectum 51:1597–1604PubMedCrossRefGoogle Scholar
  15. 15.
    Demirbas S, Akin ML, Kalemoglu M, Ogun I, Celenk T (2005) Comparison of laparoscopic and open surgery for total rectal prolapse. Surg Today 35:446–452PubMedCrossRefGoogle Scholar
  16. 16.
    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 20:1353–1359PubMedCrossRefGoogle Scholar
  17. 17.
    Raftopoulos Y, Senagore AJ, Di Giuro G, Bergamaschi R (2005) Recurrence rates after abdominal surgery for complete rectal prolapse: a multicenter pooled analysis of 643 individual patient data. Dis Colon Rectum 48:1200–1206PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Seung-Hyun Lee
    • 1
  • Paryush Lakhtaria
    • 1
  • Jorge Canedo
    • 1
  • Yoon-Suk Lee
    • 1
  • Steven D. Wexner
    • 1
    Email author
  1. 1.Department of Colorectal SurgeryCleveland Clinic FloridaWestonUSA

Personalised recommendations