Abstract
Background
Laparoscopic ventral rectopexy for rectal prolapse combines the advantages of a minimally invasive approach with the low recurrence rate observed after abdominal procedures. To date, only a few long-term functional studies and no quality of life assessment are available. The aim of this study was to assess long-term functional outcomes and quality of life after laparoscopic ventral rectopexy.
Methods
Between January 2007 and December 2008, patients who underwent laparoscopic ventral rectopexy for full-thickness external rectal prolapse and/or rectocele were prospectively included. Fecal incontinence and constipation were scored (Wexner score and Rome II criteria). Quality of life was assessed using the gastrointestinal quality of life form (GIQLI).
Results
Thirty-three patients were included and 30 (91 %) completed all the questionnaires. There was no morbidity or mortality. The mean length of hospital stay was 5 ± 1 days (range 3–7 days). After a mean follow-up of 42 ± 7 months (range 32–52 months), recurrence of rectocele was observed in two patients (6 %). At the end of follow-up, constipation was improved in 13/18 patients (72 %) and two patients (7 %) presented de novo constipation. The patients’ Wexner score improved between preoperative status and end of follow-up (12 ± 7 vs. 4 ± 3, p = 0.002). Compared to the preoperative score, quality of life significantly improved over time: 77 ± 21 preoperatively versus 107 ± 17 at 1 year versus 109 ± 18 at the end of follow-up (p < 0.001).
Conclusions
This prospective study showed that laparoscopic ventral rectopexy was associated with excellent postoperative outcomes and a low long-term recurrence rate. Long-term functional results were excellent in terms of continence, with significant improvement of quality of life and without worsening constipation.
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References
Bachoo P, Brazzelli M, Grant A (2000) Surgery for complete rectal prolapse in adults. Cochrane Database Syst Rev: CD001758; PMID:10796817
Samaranayake CB, Luo C, Plank AW, Merrie AE, Plank LD, Bissett IP (2010) Systematic review on ventral rectopexy for rectal prolapse and intussusception. Colorectal Dis 12:504–512
Madiba TE, Baig MK, Wexner SD (2005) Surgical management of rectal prolapse. Arch Surg 140:63–73
Tou S, Brown SR, Malik AI, Nelson RL (2008) Surgery for complete rectal prolapse in adults. Cochrane Database Syst Rev: CD001758; PMID:18843623
Wong M, Meurette G, Abet E, Podevin J, Lehur PA (2011) Safety and efficacy of laparoscopic ventral mesh rectopexy for complex rectocele. Colorectal Dis 13:1019–1023
D’Hoore A, Cadoni R, Penninckx F (2004) Long-term outcome of laparoscopic ventral rectopexy for total rectal prolapse. Br J Surg 91:1500–1505
Boons P, Collinson R, Cunningham C, Lindsey I (2010) Laparoscopic ventral rectopexy for external rectal prolapse improves constipation and avoids de novo constipation. Colorectal Dis 12:526–532
Portier G, Kirzin S, Cabarrot P, Queralto M, Lazorthes F (2011) The effect of abdominal ventral rectopexy on faecal incontinence and constipation in patients with internal intra-anal rectal intussusception. Colorectal Dis 13:914–917
Yoshioka K, Heyen F, Keighley MR (1989) Functional results after posterior abdominal rectopexy for rectal prolapse. Dis Colon Rectum 32:835–838
D’Hoore A, Penninckx F (2006) Laparoscopic ventral recto(colpo)pexy for rectal prolapse: surgical technique and outcome for 109 patients. Surg Endosc 20:1919–1923
Purkayastha S, Tekkis P, Athanasiou T et al (2005) A comparison of open vs. laparoscopic abdominal rectopexy for full-thickness rectal prolapse: a meta-analysis. Dis Colon Rectum 48:1930–1940
Solomon MJ, Young CJ, Eyers AA, Roberts RA (2002) Randomized clinical trial of laparoscopic versus open abdominal rectopexy for rectal prolapse. Br J Surg 89:35–39
Jorge JM, Wexner SD (1993) Etiology and management of fecal incontinence. Dis Colon Rectum 36:77–97
Slim K, Bousquet J, Kwiatkowski F, Lescure G, Pezet D, Chipponi J (1999) First validation of the French version of the Gastrointestinal Quality of Life Index (GIQLI). Gastroenterol Clin Biol 23:25–31
Thompson WG, Longstreth GF, Drossman DA, Heaton KW, Irvine EJ, Muller-Lissner SA (1999) Functional bowel disorders and functional abdominal pain. Gut 45(Suppl 2):II43–II47
D’Hoore A, Vanbeckevoort D, Penninckx F (2008) Clinical, physiological and radiological assessment of rectovaginal septum reinforcement with mesh for complex rectocele. Br J Surg 95:1264–1272
Wijffels N, Cunningham C, Dixon A, Greenslade G, Lindsey I (2011) Laparoscopic ventral rectopexy for external rectal prolapse is safe and effective in the elderly. Does this make perineal procedures obsolete? Colorectal Dis 13:561–566
Luukkonen P, Mikkonen U, Järvinen H (1992) Abdominal rectopexy with sigmoidectomy vs. rectopexy alone for rectal prolapse: a prospective, randomized study. Int J Colorectal Dis 7:219–222
Lauretta A, Bellomo RE, Galanti F, Tonizzo CA, Infantino A (2012) Laparoscopic low ventral rectocolpopexy (LLVR) for rectal and rectogenital prolapse: surgical technique and functional results. Tech Coloproctol. doi:10.1007/s10151-012-0918-2
Sezai D, Demirbas S, Akin L, Kurt Y, Ogün I, Celenk T (2005) The impact of laparoscopic resection rectopexy in patients with total rectal prolapse. Mil Med 170:743–747
Kim M, Reibetanz J, Boenicke L, Germer CT, Jayne D, Isbert C (2012) Quality of life after laparoscopic resection rectopexy. Int J Colorectal Dis 27:489–495
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Maggiori, L., Bretagnol, F., Ferron, M. et al. Laparoscopic ventral rectopexy: a prospective long-term evaluation of functional results and quality of life. Tech Coloproctol 17, 431–436 (2013). https://doi.org/10.1007/s10151-013-0973-3
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DOI: https://doi.org/10.1007/s10151-013-0973-3