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Long-term outcome after laparoscopic and open surgery for rectal prolapse

A case–control study

Surgical Endoscopy And Other Interventional Techniques volume 20, pages 35–42 (2006)Cite this article

Abstract

Background

Laparoscopic repair (LR) of rectal prolapse is potentially associated with earlier recovery and lower perioperative morbidity, as compared with open transabdominal repair (OR). Data on the long-term recurrence rate and functional outcome are limited.

Methods

Perioperative data on rectal prolapse in relation to all LRs performed between December 1991 and April 2004 were prospectively collected. The LR patients were matched by age, gender, and procedure type with OR patients who underwent surgery during the same period. Patients with previous complex abdominal surgery or a body mass index exceeding 40 were excluded from the study. Data on recurrence rate, bowel habits, continence, and satisfaction scores were collected using a telephone survey.

Results

A total of 111 patients (age, 56.8 ± 18.1 years; female, 87%) underwent attempted LR. An operative complication deferred repair in two cases. Among the 111 patients, 42 had posterior mesh fixation, and 67 had sutured rectopexy (32 patients with sigmoid colectomy for constipation). Eight patients (7.2%) had conversion to laparotomy. Matching was established for 86 patients. The LR patients had a shorter hospital stay (mean, 3.9 vs 6.0 days; p < 0.0001). The 30-day reoperation and readmission rates were similar for the two groups. The rates for recurrence requiring surgery were 9.3% for LR and 4.7% for OR (p = 0.39) during a mean follow-up period of 59 months. An additional seven patients in each group reported possible recurrence by telephone. Postoperatively, 35% of the LR patients and 53% of the OR patients experienced constipation (p = 0.09). Constipation was improved in 74% of the LR patients and 54% of the OR patients, and worsened, respectively, in 3% and 17% (p = 0.037). The postoperative incontinence rates were 30% for LR and 33% for OR (p = 0.83). Continence was improved in 48% of the LR patients and 35% of the OR patients, and worsened, respectively, in 9% and 18% (p = 0.22). The mean satisfaction rates for surgery (on a scale of 0 to10) were 7.3 for the LR patients and 8.1 for the OR patients (p = 0.17).

Conclusions

The hospital stay is shorter for LR than for OR. Both functional results and recurrent full-thickness rectal prolapse were similar for LR and OR during a mean follow-up period of 5 years.

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Author information

Affiliations

  1. Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA

    Y. Kariv, S. Casillas, J. Nocero, J. Bast, K. Brady & V. W. Fazio

  2. Division of Colorectal Surgery, University Hospitals of Cleveland, 11100 Euclid Avenue, Cleveland, OH, 44106, USA

    C. P. Delaney

  3. Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, OH, USA

    J. Hammel

  4. Department of Surgery, Medical College of Ohio, Toledo, OH, USA

    A. J. Senagore

Authors
  1. Y. Kariv
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  2. C. P. Delaney
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  3. S. Casillas
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  4. J. Hammel
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  5. J. Nocero
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  6. J. Bast
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  7. K. Brady
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  8. V. W. Fazio
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  9. A. J. Senagore
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Corresponding author

Correspondence to C. P. Delaney.

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Kariv, Y., Delaney, C.P., Casillas, S. et al. Long-term outcome after laparoscopic and open surgery for rectal prolapse. Surg Endosc 20, 35–42 (2006). https://doi.org/10.1007/s00464-005-3012-2

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  • DOI: https://doi.org/10.1007/s00464-005-3012-2

Keywords

  • Constipation
  • Incontinence
  • Laparoscopy
  • Rectal prolapse
  • Rectopexy
  • Recurrence