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Laparoscopic ventral rectopexy in male patients with external rectal prolapse is associated with a high reoperation rate

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Abstract

Background

Laparoscopic ventral rectopexy has been used to treat male patients with external rectal prolapse, but evidence to support this approach is scarce. The aim of this study was to evaluate the results of this new abdominal rectopexy surgical technique in men.

Methods

This was a retrospective multicenter study. Adult male patients who were operated on for external rectal prolapse using ventral rectopexy in five tertiary hospitals in Finland between 2006 and 2014 were included in the study. Patient demographics, detailed operative, postoperative and short-term follow-up data were collected from patient registers in participating hospitals. A questionnaire and informed consent form was sent to all patients. The questionnaire included scores for anal incontinence, obstructed defecation syndrome, urinary symptoms and sexual dysfunction. The main outcome measure was the incidence of recurrent rectal prolapse. Surgical morbidity, the need for surgical repair due to recurrent symptoms and functional outcomes were secondary outcome measures.

Results

A total of 52 adult male patients with symptoms caused by external rectal prolapse underwent ventral rectopexy. The questionnaire response rate was 64.4 %. Baseline clinical characteristics and perioperative results were similar in the responder and non-responder groups. A total of 9 (17.3 %) patients faced complications. There were two (3.8 %) serious surgical complications during the 30-day period after surgery that necessitated reoperation. None of the complications were mesh related. Recurrence of the prolapse was noticed in nine patients (17 %), and postoperative mucosal anal prolapse symptoms persisted in 11 patients (21 %). As a result, the reoperation rate was high. Altogether, 17 patients (33 %) underwent reoperation during the follow-up period due to postoperative complications or recurrent rectal or mucosal prolapse. According to the postoperative questionnaire data, patients under 40 had good functional results in terms of anal continence, defecation, urinary functions and sexual activity.

Conclusions

Laparoscopic ventral rectopexy is a safe surgical procedure in male patients with external prolapse. However, a high overall reoperation rate was noticed due to recurrent rectal and residual mucosal prolapse. This suggests that the ventral rectopexy technique should be modified or combined with other abdominal or perineal methods when treating male rectal prolapse patients.

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Authors and Affiliations

  1. Division of Gastroenterology, Department of Surgery, Oulu University Hospital, Oulu, Finland

    T. Rautio, J. Mäkelä-Kaikkonen, P. Ohtonen & J. Mäkelä

  2. Division of Urology, Department of Surgery, University Hospital of Oulu, Oulu, Finland

    M. Vaarala

  3. Department of Surgery, Keski-Suomi Central Hospital, Jyväskylä, Finland

    M. Kairaluoma

  4. Department of Surgery, Kanta-Häme Central Hospital, Hämeenlinna, Finland

    J. Kössi

  5. Department of Surgery, University of Turku, Turku, Finland

    J. Kössi

  6. Department of Gastrointestinal Surgery, Helsinki University Central Hospital, Helsinki, Finland

    M. Carpelan-Holmström & S. Salmenkylä

  7. Medical Research Center Oulu, University of Oulu, Oulu, Finland

    T. Rautio, J. Mäkelä-Kaikkonen, P. Ohtonen & J. Mäkelä

Authors
  1. T. Rautio
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  2. J. Mäkelä-Kaikkonen
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  3. M. Vaarala
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  4. M. Kairaluoma
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  5. J. Kössi
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  6. M. Carpelan-Holmström
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  7. S. Salmenkylä
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  8. P. Ohtonen
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  9. J. Mäkelä
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Correspondence to T. Rautio.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The local ethics council of Oulu University Hospital (Oulu, Finland) approved the present study, which was conducted according to the Declaration of Helsinki.

Informed consent

Written consent from the patients was not obtained, but the volunteers responding to the original survey was considered as consent to participate in the present study. The National Institute for Health and Welfare (Helsinki, Finland), approved the present study and the use of registry data following local ethical approval, according to the Finnish law.

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Rautio, T., Mäkelä-Kaikkonen, J., Vaarala, M. et al. Laparoscopic ventral rectopexy in male patients with external rectal prolapse is associated with a high reoperation rate. Tech Coloproctol 20, 715–720 (2016). https://doi.org/10.1007/s10151-016-1528-1

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  • DOI: https://doi.org/10.1007/s10151-016-1528-1

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