Outcome of laparoscopic rectopexy versus perineal rectosigmoidectomy for full-thickness rectal prolapse in elderly patients
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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.
The objective of this study was to evaluate safety and efficacy of laparoscopic rectopexy compared with perineal rectosigmoidectomy for FTRP in elderly patients.
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).
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.
Laparoscopic rectopexy is a safe and feasible procedure in elderly patients with FTRP but results in increased operative time.
KeywordsColorectal Laparoscopic rectopexy Rectal prolapse Perineal rectosigmoidectomy Elderly Altemeier procedure
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.
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