PURPOSE
This study has been undertaken to audit a single-center experience with laparoscopically-assisted resection rectopexy for full-thickness rectal prolapse. The clinical outcomes and long-term results were evaluated.
METHODS
The data were prospectively collected for the duration of the operation, time to passage of flatus postoperatively, hospital stay, morbidity, and mortality. For follow-up, patients received a questionnaire or were contacted. The data were divided into quartiles over the study period, and the differences in operating time and length of hospital stay were tested using the Kruskal-Wallis test.
RESULTS
Between March 1992 and October 2003, a total of 117 patients underwent laparoscopic resection rectopexy for rectal prolapse. The median operating time during the first quartile (representing the early experience) was 180 minutes compared with 110 minutes for the fourth quartile (Kruskal-Wallis test for operating time = 35.523, 3 df, P < 0.0001). Overall morbidity was 9 percent (ten patients), with one death (<1 percent). One patient had a ureteric injury requiring conversion. One minor anastomotic leak occurred, necessitating laparoscopic evacuation of a pelvic abscess. Altogether, 77 patients were available for follow-up. The median follow-up was 62 months. Eighty percent of the patients reported alleviation of their symptoms after the operation. Sixty-nine percent of the constipated patients experienced an improvement in bowel frequency. No patient had new or worsening symptoms of constipation after surgery. Two (2.5 percent) patients had full-thickness rectal prolapse recurrence. Mucosal prolapse recurred in 14 (18 percent) patients. Anastomotic dilation was performed for stricture in five (4 percent) patients.
CONCLUSIONS
Laparoscopically-assisted resection rectopexy for rectal prolapse provides a favorable functional outcome and low recurrence rate. Shorter operating time is achieved with experience. The minimally invasive technique benefits should be considered when offering rectal prolapse patients a transabdominal approach for repair, and emphasis should now be on advanced training in the laparoscopic approach.
Similar content being viewed by others
REFERENCES
KI Deen E Grant C Billingham MR Keighley (1994) ArticleTitleAbdominal resection rectopexy with pelvic floor repair versus perineal rectosigmoidectomy and pelvic floor repair for full thickness rectal prolapse Br J Surg 81 302–4 Occurrence Handle1:STN:280:ByuB3cjns1I%3D Occurrence Handle8156369
CA Kupfer JC Goligher (1970) ArticleTitleOne hundred consecutive cases of complete prolapse of the rectum treated by operation Br J Surg 57 481–7
HE Lockhart-Mummery (1972) ArticleTitleSymposium procidentia: recent experiences in the treatment of rectal prolapse Dis Colon Rectum 15 347–50 Occurrence Handle1:STN:280:CSyD3cjgt1w%3D Occurrence Handle5072255
Blus JG. In: Fazio VW, ed. Current therapy in colon and rectal surgery. Philadelphia: B.C. Decker, 1990:92–7
HM Frykman SM Goldberg (1969) ArticleTitleThe surgical treatment of rectal procidentia Surg Gynecol Obstet 129 1225–30 Occurrence Handle1:STN:280:CS%2BD3sfotVc%3D Occurrence Handle5353418
J Safyan M Pinho J Alexander-Williams MR Keighley (1990) ArticleTitleSutured posterior abdominal rectopexy Br J Surg 77 143–5 Occurrence Handle2317672
GS Duthie DC Bartolo (1992) ArticleTitleAbdominal rectopexy for rectal prolapse: a comparison of techniques Br J Surg 79 107–13 Occurrence Handle1:STN:280:By2B3cfmslQ%3D Occurrence Handle1555053
GS Duthie DC Bartolo (1989) ArticleTitleA comparison between Marlex and resection rectopexy Neth J Surg 41 136–9 Occurrence Handle1:STN:280:By%2BC3sjktVU%3D Occurrence Handle2616018
RF Mckee JC Lauder FW Poon MA Altchison IG Finlay (1992) ArticleTitleA prospective randomized study of abdominal rectopexy with and without sigmoidectomy in rectal prolapse Surg Gynecol Obstet 174 145–8 Occurrence Handle1:STN:280:By2C3s3nvVw%3D Occurrence Handle1734574
MJ Solomon AA Eyers (1996) ArticleTitleLaparoscopic rectopexy using mesh fixation with a spiked chromium staple Dis Colon Rectum 39 279–84 Occurrence Handle1:STN:280:BymC1cvkslw%3D Occurrence Handle8603548
InstitutionalAuthorNameHenery LG (1994) ArticleTitleCattey RP. Rectal prolapse Surg Laparosc Endosc 4 357–60
R Baker AJ Senagore MA Lutchtefeld (1995) ArticleTitleLaparoscopic-assisted vs. open resection: rectopexy offers excellent results Dis Colon Rectum 38 199–201 Occurrence Handle1:STN:280:ByqC2Mvgslc%3D Occurrence Handle7851177
SP Kwok DP Carey WY Lau AK Li (1994) ArticleTitleLaparoscopic rectopexy Dis Colon Rectum 37 947–8 Occurrence Handle1:STN:280:ByuA2MjgsV0%3D Occurrence Handle8076497
W Graf T Stefanson D Arvidson L Pahlmann (1995) ArticleTitleLaparoscopic suture rectopexy Dis Colon Rectum 38 211–2 Occurrence Handle1:STN:280:ByqC2MvgslI%3D Occurrence Handle7851180
A Cuschieri SM Shimi G Vander Velpen S Banting R Wood (1994) ArticleTitleLaparoscopic prosthesis fixation rectopexy for rectal prolapse Br J Surg 81 138–9 Occurrence Handle1:STN:280:ByuC2cjgs1M%3D Occurrence Handle8313092
A Darzi MM Henery PJ Guillou P Shorvon JR Monson (1995) ArticleTitleStapled laparoscopic rectopexy for rectal prolapse Surg Endosc 9 301–3 Occurrence Handle1:STN:280:ByqA38%2Fns1c%3D Occurrence Handle7597603
AR Stevenson RW Stitz JW Lumley (1998) ArticleTitleLaparoscopic–assisted resection rectopexy for rectal prolapse: early and medium follow-up Dis Colon Rectum 41 46–54 Occurrence Handle1:STN:280:DyaK1c7mvFWgsg%3D%3D Occurrence Handle9510310
GG Browning AG Parks (1983) ArticleTitlePostanal repair for neuropathic faecal incontinence: correlation of clinical result and anal canal pressures Br J Surg 70 101–4 Occurrence Handle1:STN:280:BiyC38fitVA%3D Occurrence Handle6824891
RD Madoff JG Williams WD Wong DA Rothenberger SM Goldberg (1992) ArticleTitleLong term functional results of colon resection and rectopexy for overt rectal prolapse Am J Gastroenterol 87 101–4 Occurrence Handle1:STN:280:By2D1Mris1Y%3D Occurrence Handle1728105
FT Huber H Stein JR Siewert (1995) ArticleTitleFunctional results after treatment of rectal prolapse with rectopexy and sigmoid resection World J Surg 19 138–43 Occurrence Handle1:STN:280:ByqB2MbjsFA%3D Occurrence Handle7740801
CT Speakman MV Madden RJ Nicholls MA Kamm (1991) ArticleTitleLateral ligament division during rectopexy causes constipation but prevents recurrences: results of prospective, randomized study Br J Surg 78 1431–3 Occurrence Handle1:STN:280:By2C38jjvFc%3D Occurrence Handle1773316
R Farouk GS Duthie AB MacGregor DC Bartolo (1994) ArticleTitleRectoanal inhibition and incontinence in patients with rectal prolapse Br J Surg 81 743–6 Occurrence Handle1:STN:280:ByuA3MbotlQ%3D Occurrence Handle8044569
JD Watts DA Rothenberger JG Buls SM Goldberg S Nivatvongs (1985) ArticleTitleThe management of procidentia: 30 years experience Dis Colon Rectum 28 96–102 Occurrence Handle1:STN:280:BiqC38njtlY%3D Occurrence Handle3971814
SJ Snooks MM Henery M Swash (1985) ArticleTitleAnorectal incontinence and rectal prolapse: differential assessment of the innervation of puborectalis and external anal sphincter muscles Gut 26 470–6 Occurrence Handle1:STN:280:BiqB3crks1U%3D Occurrence Handle3996937
R Farouk GS Duthie DC Bartolo AB MacGregor (1992) ArticleTitleRestoration of continence following rectopexy for rectal prolapse is associated with recovery of the internal anal electromyogram Br J Surg 79 439–40 Occurrence Handle1:STN:280:By2B1c3jvF0%3D Occurrence Handle1596729
KG Atkinson DC Tylor (1984) ArticleTitleWells procedure for complete rectal prolapse: a 10 year experience Dis Colon Rectum 27 96–8 Occurrence Handle1:STN:280:BiuC3s7ks1I%3D Occurrence Handle6697838
JCB Penfold PR Hawley (1972) ArticleTitleExperience of Ivalon-sponge implant for complete rectal prolapse at St. Mark’s Hospital, 1960-1970 Br J Surg 59 846–8 Occurrence Handle1:STN:280:CSyD2M%2FjvVY%3D Occurrence Handle4637085
JA Solla DA Rothenberger SM Goldberg (1989) ArticleTitleSurgical techniques in prolapse of the rectum Langenbecks Arch Chir 6 370–6
IH Kellokumpu J Vironen T Scheinin (2000) ArticleTitleLaparoscopic repair of rectal prolapse: a prospective study evaluating surgical outcome and changes in symptoms and bowel function Surg Endosc 14 634–40 Occurrence Handle1:STN:280:DC%2BD3M7gvFWmtw%3D%3D Occurrence Handle10948299
WC Cirrocco AC Browen (1993) ArticleTitleAnterior resection for the treatment of rectal prolapse: a 20 year experience Am Surg 5 265–9
S Benoist N Taffinder S Gould A Chang A Darzi (2001) ArticleTitleFunctional results two years after laparoscopic rectopexy Am J Surg 182 168–73 Occurrence Handle1:STN:280:DC%2BD3Mrisl2iuw%3D%3D Occurrence Handle11574090
BT Stewart RW Stitz JW Lumley (1999) ArticleTitleLaparoscopic assisted colorectal surgery in the elderly Br J Surg 86 938–41 Occurrence Handle10.1046/j.1365-2168.1999.01160.x Occurrence Handle1:STN:280:DyaK1MzkvVKmtw%3D%3D Occurrence Handle10417569
Author information
Authors and Affiliations
Additional information
Reprints are not available.
About this article
Cite this article
Ashari, L., Lumley, J., Stevenson, A. et al. Laparoscopically-Assisted Resection Rectopexy for Rectal Prolapse: Ten Years’ Experience. Dis Colon Rectum 48, 982–987 (2005). https://doi.org/10.1007/s10350-004-0886-3
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10350-004-0886-3