Laparoscopic Ventral Rectopexy for Rectal Prolapse

Abstract

Rectal prolapse is the circumferential, full-thickness intussusception of the rectal wall with protrusion beyond the anal canal. The principles for the surgical management of full-thickness external rectal prolapse can be distilled into four basic objectives: the restoration of anatomy with the aim of improving function, whilst minimising morbidity and avoiding the onset of new symptoms. The plethora of surgical procedures described to treat external rectal prolapse (via both perineal and abdominal approaches) attests to the difficulty of successfully satisfying all four of these goals with one procedure. In general, abdominal rectopexy is considered preferable to perineal procedures, having the advantage of lower recurrence rates and superior improvement of incontinence (Brazzelli et al., Database Syst Rev 2:CD001758, 2000). However, the abdominal approach is invasive and is associated with poor correction (and often induction) of constipation. The less invasive nature of perineal procedures has resulted in their wide use for elderly or medically unfit patients, but at the expense of high recurrence rates and unpredictable recovery of function, particularly incontinence. A laparoscopic approach has been shown to be superior to open rectopexy in a prospective, randomised controlled trial, with improved perioperative morbidity, decreased postoperative pain and reduced length of stay (Solomon et al., Br J Surg 89:35–39, 2002).