Skip to main content

Advertisement

SpringerLink
Log in

Outcome analysis of elderly patients undergoing laparoscopic resection rectopexy for rectal prolapse

  • Original Article
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

For treatment of rectal prolapse, abdominal approaches are generally offered to younger patients, whereas perineal, less invasive procedures are considered more beneficial in the elderly. The aim of this study was to analyze whether laparoscopic resection rectopexy (LRR) is suitable for older patients.

Patients/Methods

Patients who received LRR for rectal prolapse were selected from a prospective laparoscopic colorectal surgery database. Perioperative and long-term outcome were compared between patients <75 years old (group A) and ≥75 years old (group B).

Results

Of 154 patients, 111 were in group A and 43 in group B. There was one conversion that occurred in group B. Overall mortality rate was 1.3% (n = 2). Both patients were in group B (group B, 4.7%; p = 0.079). Differences in major and minor complications between the groups were not significant. Rates of improvement for incontinence were 62.7% (group A) and 66.7% (group B; p = 0.716); for constipation, the rates were 78.9% (group A) and 73.3% (group B; p = 0.832). All recurrences occurred in group A (n = 10; overall, 10.3%; group A, 13%). After exclusion of patients who had previously received perineal prolapse surgery, recurrence rate was 3.3% overall (group A, 4.3%).

Conclusions

This study supports the benefits of LRR for rectal prolapse in elderly patients. Age per se is not a contraindication for LRR. Elderly patients encounter complications slightly more frequently (although not statistically significant) than younger patients. Therefore, a very careful patient selection in the elderly is of paramount importance. However, the long-term outcome does not seem to differ between younger and elderly patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Destatis Deutsches Statistisches Bundesamt. http://www.destatis.de/alterspyramide/. Accessed September 8 2010

  2. Schwandner O, Schiedeck TH, Bruch HP (1999) Advanced age—indication or contraindication for laparoscopic colorectal surgery? Dis Colon Rectum 42(3):356–362

    Article  PubMed  CAS  Google Scholar 

  3. A comparison of laparoscopically assisted and open colectomy for colon cancer (2004). N Engl J Med 350 (20):2050–2059. doi:10.1056/NEJMoa032651

    Google Scholar 

  4. Alves A, Panis Y, Slim K, Heyd B, Kwiatkowski F, Mantion G (2005) French multicentre prospective observational study of laparoscopic versus open colectomy for sigmoid diverticular disease. Br J Surg 92(12):1520–1525. doi:10.1002/bjs.5148

    Article  PubMed  CAS  Google Scholar 

  5. Chautard J, Alves A, Zalinski S, Bretagnol F, Valleur P, Panis Y (2008) Laparoscopic colorectal surgery in elderly patients: a matched case-control study in 178 patients. J Am Coll Surg 206(2):255–260. doi:10.1016/j.jamcollsurg.2007.06.316

    Article  PubMed  Google Scholar 

  6. Frasson M, Braga M, Vignali A, Zuliani W, Di Carlo V (2008) Benefits of laparoscopic colorectal resection are more pronounced in elderly patients. Dis Colon Rectum 51(3):296–300. doi:10.1007/s10350-007-9124-0

    Article  PubMed  Google Scholar 

  7. Senagore AJ, Madbouly KM, Fazio VW, Duepree HJ, Brady KM, Delaney CP (2003) Advantages of laparoscopic colectomy in older patients. Arch Surg 138(3):252–256

    Article  PubMed  Google Scholar 

  8. Stocchi L, Nelson H, Young-Fadok TM, Larson DR, Ilstrup DM (2000) Safety and advantages of laparoscopic vs. open colectomy in the elderly: matched-control study. Dis Colon Rectum 43(3):326–332

    Article  PubMed  CAS  Google Scholar 

  9. Matzel KE, Heuer S, Zhang W (2008) Rectal prolapse. Abdominal or local approach. Chirurg 79(5):444–451. doi:10.1007/s00104-008-1546-2

    Article  PubMed  CAS  Google Scholar 

  10. Schiedeck TH, Schwandner O, Scheele J, Farke S, Bruch HP (2005) Rectal prolapse: which surgical option is appropriate? Langenbecks Arch Surg 390(1):8–14. doi:10.1007/s00423-004-0459-x

    Article  PubMed  CAS  Google Scholar 

  11. Steele SR, Goetz LH, Minami S, Madoff RD, Mellgren AF, Parker SC (2006) Management of recurrent rectal prolapse: surgical approach influences outcome. Dis Colon Rectum 49(4):440–445. doi:10.1007/s10350-005-0315-2

    Article  PubMed  Google Scholar 

  12. Lieberth M, Kondylis LA, Reilly JC, Kondylis PD (2009) The Delorme repair for full-thickness rectal prolapse: a retrospective review. Am J Surg 197(3):418–423. doi:10.1016/j.amjsurg.2008.11.012

    Article  PubMed  Google Scholar 

  13. Madiba TE, Baig MK, Wexner SD (2005) Surgical management of rectal prolapse. Arch Surg 140(1):63–73. doi:10.1001/archsurg.140.1.63

    Article  PubMed  Google Scholar 

  14. Laubert T, Kleemann M, Schorcht A, Czymek R, Jungbluth T, Bader FG, Bruch HP, Roblick UJ (2010) Laparoscopic resection rectopexy for rectal prolapse: a single-center study during 16 years. Surg Endosc. doi:10.1007/s00464-010-0962-9

  15. Bruch HP, Herold A, Schiedeck T, Schwandner O (1999) Laparoscopic surgery for rectal prolapse and outlet obstruction. Dis Colon Rectum 42(9):1189–1194, discussion 1194-1185

    Article  PubMed  CAS  Google Scholar 

  16. Bachoo PBM, Grant A (2003) Surgery for complete rectal prolapse in adults (Cochrane Reveiw). The Cochrane Library (Issue 3)

  17. Tou S, Brown SR, Malik AI, Nelson RL (2008) Surgery for complete rectal prolapse in adults. Cochrane Database Syst Rev 4:CD001758. doi:10.1002/14651858.CD001758.pub2

    PubMed  Google Scholar 

  18. Vignali A, Di Palo S, Tamburini A, Radaelli G, Orsenigo E, Staudacher C (2005) Laparoscopic vs. open colectomies in octogenarians: a case-matched control study. Dis Colon Rectum 48(11):2070–2075. doi:10.1007/s10350-005-0147-0

    Article  PubMed  Google Scholar 

  19. Tuech JJ, Pessaux P, Rouge C, Regenet N, Bergamaschi R, Arnaud JP (2000) Laparoscopic vs open colectomy for sigmoid diverticulitis: a prospective comparative study in the elderly. Surg Endosc 14(11):1031–1033. doi:10.1007/s004640000267[pii]

    Article  PubMed  CAS  Google Scholar 

  20. Lechaux JP, Lechaux D, Perez M (1995) Results of Delorme’s procedure for rectal prolapse. Advantages of a modified technique. Dis Colon Rectum 38(3):301–307

    Article  PubMed  CAS  Google Scholar 

  21. Marchal F, Bresler L, Ayav A, Zarnegar R, Brunaud L, Duchamp C, Boissel P (2005) Long-term results of Delorme’s procedure and Orr-Loygue rectopexy to treat complete rectal prolapse. Dis Colon Rectum 48(9):1785–1790. doi:10.1007/s10350-005-0088-7

    Article  PubMed  Google Scholar 

  22. Kimmins MH, Evetts BK, Isler J, Billingham R (2001) The Altemeier repair: outpatient treatment of rectal prolapse. Dis Colon Rectum 44(4):565–570

    Article  PubMed  CAS  Google Scholar 

  23. Wijffels N, Cunningham C, Dixon A, Greenslade G, Lindsey I (2010) Laparoscopic anterior rectopexy for external rectal prolapse is safe and effective in the elderly. Does this make perineal procedures obsolete? Colorectal Dis. doi:10.1111/j.1463-1318.2010.02242.x

  24. Ashari LH, Lumley JW, Stevenson AR, Stitz RW (2005) Laparoscopically-assisted resection rectopexy for rectal prolapse: ten years’ experience. Dis Colon Rectum 48(5):982–987. doi:10.1007/s10350-004-0886-3

    Article  PubMed  Google Scholar 

  25. Kariv Y, Delaney CP, Casillas S, Hammel J, Nocero J, Bast J, Brady K, Fazio VW, Senagore AJ (2006) Long-term outcome after laparoscopic and open surgery for rectal prolapse: a case-control study. Surg Endosc 20(1):35–42. doi:10.1007/s00464-005-3012-2

    Article  PubMed  CAS  Google Scholar 

  26. Benoist S, Taffinder N, Gould S, Chang A, Darzi A (2001) Functional results two years after laparoscopic rectopexy. Am J Surg 182(2):168–173

    Article  PubMed  CAS  Google Scholar 

  27. Stevenson AR, Stitz RW, Lumley JW (1998) Laparoscopic-assisted resection-rectopexy for rectal prolapse: early and medium follow-up. Dis Colon Rectum 41(1):46–54

    Article  PubMed  CAS  Google Scholar 

  28. Gourgiotis S, Baratsis S (2007) Rectal prolapse. Int J Colorectal Dis 22(3):231–243. doi:10.1007/s00384-006-0198-2

    Article  PubMed  Google Scholar 

  29. Johansen OB, Wexner SD, Daniel N, Nogueras JJ, Jagelman DG (1993) Perineal rectosigmoidectomy in the elderly. Dis Colon Rectum 36(8):767–772

    Article  PubMed  CAS  Google Scholar 

  30. Liberman H, Hughes C, Dippolito A (2000) Evaluation and outcome of the Delorme procedure in the treatment of rectal outlet obstruction. Dis Colon Rectum 43(2):188–192

    Article  PubMed  CAS  Google Scholar 

  31. Friedman R, Muggia-Sulam M, Freund HR (1983) Experience with the one-stage perineal repair of rectal prolapse. Dis Colon Rectum 26(12):789–791

    Article  PubMed  CAS  Google Scholar 

  32. Byrne CM, Smith SR, Solomon MJ, Young JM, Eyers AA, Young CJ (2008) Long-term functional outcomes after laparoscopic and open rectopexy for the treatment of rectal prolapse. Dis Colon Rectum 51(11):1597–1604. doi:10.1007/s10350-008-9365-6

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We thank Mrs. C. Killaitis for statistics and for keeping the database updated.

Author information

Authors and Affiliations

  1. Department of Surgery, University of Schleswig-Holstein Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany

    Tilman Laubert, Franz G. Bader, Markus Kleemann, Hamed Esnaashari, Ralf Bouchard, Philipp Hildebrand, Erik Schlöricke, Hans-Peter Bruch & Uwe J. Roblick

Authors
  1. Tilman Laubert
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Franz G. Bader
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Markus Kleemann
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hamed Esnaashari
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ralf Bouchard
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Philipp Hildebrand
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Erik Schlöricke
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Hans-Peter Bruch
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Uwe J. Roblick
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tilman Laubert.

Additional information

The authors declare that they have no conflict of interest

Rights and permissions

Reprints and permissions

About this article

Cite this article

Laubert, T., Bader, F.G., Kleemann, M. et al. Outcome analysis of elderly patients undergoing laparoscopic resection rectopexy for rectal prolapse. Int J Colorectal Dis 27, 789–795 (2012). https://doi.org/10.1007/s00384-011-1395-1

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-011-1395-1

Keywords

Search

Navigation