Abstract
Background
Many different techniques to treat rectal prolapse have been introduced. Laparoscopic resection rectopexy has been shown to entail benefits regarding both perioperative results and short-term outcome, whereas data for long-term outcome are scarce.
Methods
Between 1993 and 2008, all laparoscopic resection rectopexies for rectal prolapse II° or III° were selected from a prospective laparoscopic colorectal surgery database. We analyzed demographic, perioperative, and follow-up results. We defined two periods (1993–2000 and 2001–2008) for comparison of data. Long-term follow-up was obtained by sending questionnaires to all patients. Evaluation included constipation, incontinence, and recurrence of prolapse.
Results
Between January 1993 and November 2008, we performed 152 laparoscopic resection rectopexies for rectal prolapse. Median age was 64.1 years (±14.6). Conversion rate was 0.7% (1), mean operation time was 204 (±65.3) min, and was significantly shorter in the second period compared with the first (P < 0.0001). Mortality was 0.7% (n = 1). Complication rates were 4% (n = 6; major) and 19.2% (n = 29; minor), respectively. Mean length of hospital stay was 11.3 (±6.4) days and was significantly shorter in the second period compared with the first period (P < 0.0001). Mean time of follow-up was 47.7 (±41.6) months. Improvement or complete elimination of constipation was stated by 81.3% (65), and improvement or elimination of incontinence was stated by 67.3% (72). Overall recurrence rate was 11.1% (n = 10) with a rate of 5.6% (n = 5) for a 5-year period. Of those patients with previous perineal surgery for rectal prolapse, 53.8% (7/13) experienced recurrent prolapse after laparoscopic resection rectopexy in contrast to 3.9% (3/77) of patients without previous perineal prolapse surgery (P < 0.0001).
Conclusions
Our data support the benefits of laparoscopic resection rectopexy for rectal prolapse regarding both perioperative results and long-term functional outcome. Preceding perineal or open abdominal operations have an impact on recurrence after laparoscopic resection rectopexy.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Matzel KE, Heuer S, Zhang W (2008) Rectal prolapse. Abdominal or local approach. Chirurg 79:444–451
Schiedeck TH, Schwandner O, Scheele J, Farke S, Bruch HP (2005) Rectal prolapse: which surgical option is appropriate? Langenbecks Arch Surg 390:8–14
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 49:440–445
Lieberth M, Kondylis LA, Reilly JC, Kondylis PD (2009) The Delorme repair for full-thickness rectal prolapse: a retrospective review. Am J Surg 197:418–423
Tou S, Brown SR, Malik AI, Nelson RL (2008) Surgery for complete rectal prolapse in adults. Cochrane Database Syst Rev 4:CD001758
Madiba TE, Baig MK, Wexner SD (2005) Surgical management of rectal prolapse. Arch Surg 140:63–73
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 92:1520–1525
Bruch HP, Herold A, Schiedeck T, Schwandner O (1999) Laparoscopic surgery for rectal prolapse and outlet obstruction. Dis Colon Rectum 41:1189–1194
Ashari LH, Lumley JW, Stevenson AR, Stitz RW (2005) Laparoscopically-assisted resection rectopexy for rectal prolapse: ten years’ experience. Dis Colon Rectum 48:982–987
Xynos E, Chrysos E, Tsiaoussis J, Epanomeritakis E, Vassilakis JS (1999) Resection rectopexy for rectal prolapse. The laparoscopic approach. Surg Endosc 13:862–864
Benoist S, Taffinder N, Gould S, Chang A, Darzi A (2001) Functional results two years after laparoscopic rectopexy. Am J Surg 182:168–173
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 20:35–42
Stevenson AR, Stitz RW, Lumley JW (1998) Laparoscopic-assisted resection-rectopexy for rectal prolapse: early and medium follow-up. Dis Colon Rectum 41:46–54
Madbouly KM, Senagore AJ, Delaney CP, Duepree HJ, Brady KM, Fazio VW (2002) Clinically based management of rectal prolapse. Surg Endosc 17:99–103
Byrne CM, Smith SR, Solomon MJ, Young JM, Eyers AA, Young CJ (2008) Long-term functions outcomes after laparoscopic and open rectopexy for the treatment of rectal prolapse. Dis Colon Rectum 51:1597–1604
Raftopoulos Y, Senagore AJ, Di Giuro G, Bergamaschi R (2005) Recurrence rates after abdominal surgery for complete rectal prolapse: a multicenter pooled analysis of 643 individual patient data. Dis Colon Rectum 48:1200–1206
DiGiuro G, Ignajotvic D, Brogger J, Bergamaschi R (2006) How accurate are published recurrence rated after rectal prolapse surgery? A meta-analysis of individual patient data. Am J Surg 191:773–778
Acknowledgment
We thank Mrs C. Killailis for keeping the database updated.
Disclosures
Drs. Laubert, Kleemann, Schorcht, Czymek, Jungbluth, Bader, Bruch, and Roblick have no conflicts of interest or financial ties to disclose.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Laubert, T., Kleemann, M., Schorcht, A. et al. Laparoscopic resection rectopexy for rectal prolapse: a single-center study during 16 years. Surg Endosc 24, 2401–2406 (2010). https://doi.org/10.1007/s00464-010-0962-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-010-0962-9