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Laparoscopic ventral rectopexy in an elderly population with external rectal prolapse: clinical and anal manometric results

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Abstract

Aim

We report the clinical and anal manometric results of elderly patients treated with laparoscopic ventral rectopexy (LVR) for full-thickness rectal prolapse.

Method

From March 2009 to June 2012, patients were consecutively included. A modified laparoscopic Orr-Loygue procedure with posterior mobilisation was used. The patients were evaluated preoperatively, 2 months postoperatively and after 1 year. We registered Wexner incontinence scores and laxative uses by a questionnaire and performed simple anal manometry.

Results

A total of 46 patients underwent operation, all women. The median age was 83 years (range 34–99), median prolapse size was 8 cm (range 2–15), and 30 % had previous prolapse surgery. The median operative time was 135 min (range 90–215), and the median length of stay was 2 days (range 1–14). The 30-day morbidity rate was 15 %, and there were two (4 %) deaths within 30 days. There was a significant reduction in incontinence scores after 2 months and 1 year. The anal resting pressures improved from 10 cm H2O slightly to 16 cm H2O after 2 months, significantly, and still significant after 1 year at 13 cm H2O. There were no changes in the use of laxatives. The median follow-up time was 1.5 years (range 0.5–3), and there were two prolapse recurrences (4 %) in this period.

Conclusions

Laparoscopic ventral rectopexy with posterior mobilisation seems to be effective and relatively well tolerated, although not without mortality in elderly debilitated patients. It improves incontinence. With increased life-year expectance, these patients may benefit from a lower risk of recurrence compared with perineal procedures.

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Authors and Affiliations

  1. Digestive Disease Center, Bispebjerg Hospital, Bispebjerg Bakke 23, 2400, Copenhagen, Denmark

    Trine Bjerke & Tommie Mynster

Authors
  1. Trine Bjerke
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  2. Tommie Mynster
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Correspondence to Trine Bjerke.

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What does this paper add to the literature?

In a population of elderly frail patients who tolerate and gain from a laparoscopic procedure for rectal prolapse, we present anal manometric results to support the findings of improved incontinence. We discuss the difference of results with respect of age in other study populations.

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Bjerke, T., Mynster, T. Laparoscopic ventral rectopexy in an elderly population with external rectal prolapse: clinical and anal manometric results. Int J Colorectal Dis 29, 1257–1262 (2014). https://doi.org/10.1007/s00384-014-1960-5

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  • DOI: https://doi.org/10.1007/s00384-014-1960-5

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