Resection rectopexy for rectal prolapse

Background: Resection rectopexy through open laparotomy is an established procedure for the treatment of rectal prolapse. Methods: Resection rectopexy was successfully performed in 10 multiparous women by the laparoscopic approach (LAP), and the results were compared to those of eight women with laparotomy resection rectopexy (OPEN). Preoperative and postoperative assessment included anorectal manometry, defecography, and measurement of large-bowel transit. Results: The duration of the operation was longer in the LAP than in the OPEN group (p < 0.01). Morbidity was lower (p < 0.01) and hospital stay was shorter (p < 0.001) after the LAP than in the OPEN group. Prolapse was cured in all cases. Postoperatively, anal resting and squeeze pressures and rectal compliance increased significantly in both groups of patients (p= 0.007, p= 0.003, and p < 0.001, respectively). In all patients, the operation resulted in acceleration of large-bowel transit (p < 0.001) and in more obtuse anorectal angles at rest (p= 0.007). In addition, sampling events were observed more commonly (p= 0.008) postoperatively. Preoperatively, incontinence was present in 13 patients (seven LAP and six OPEN) and persisted in four of them after rectopexy (two LAP and two OPEN). Conclusions: Resection rectopexy for rectal prolapse can be performed safely via the laparoscopic route. Recovery is uneventful and of shorter duration after the laparoscopic than after the open approach. Similarly satisfactory functional results are obtained with both procedures. Received: 16 February 1998/Accepted: 2 September 1998     

Laparoscopic rectopexy for complete rectal prolapse

Background: The purpose of this study was to evaluate the clinical outcome of laparoscopic rectopexy and its effect on anorectal function investigations. Methods: Twelve patients with complete rectal prolapse without constipation underwent laparoscopic rectopexy. Pre- and postoperative evaluation included scoring of incontinence, anorectal manometry, and anal endosonography. Results: No recurrences of rectal prolapse were seen (median follow-up 19 months). Continence improved in eight of nine preoperatively incontinent patients. Two patients had mild constipation after surgery. Median maximum basal pressure measured by anorectal manometry increased from 20 to 25 mmHg (p=0.005) and the rectoanal inhibitory reflex improved in seven patients (p=0.03). Rectal sensitivity did not change significantly. Endosonography showed asymmetry and thickening of the internal anal sphincter and submucosa preoperatively. After surgery the maximum internal anal sphincter thickness decreased from 3.0 mm to 2.6 mm (p=0.02). Conclusions: Laparoscopic rectopexy improved continence in our patients. Anorectal function tests show a partial recovery of the internal anal sphincter. Laparoscopic rectopexy combines the low morbidity of minimal invasive surgery with the good outcome of abdominal rectopexy.Presented at the annual meeting of the Society of American Gastrointestinal Endoscopic Surgeons (SAGES), Orlando, Florida, USA, 11–14 March 1995     

Stapled laparoscopic rectopexy for rectal prolapse

The widespread success of laparoscopic cholecystectomy has led to the development of a wide range of laparoscopic surgical procedures. Procedures for treating rectal prolapse (Procidentia) may constitute some of the best applications for colorectal laparoscopic techniques. A technique of laparoscopic rectopexy performed using the endo-stapler is described. Twenty-nine consecutive patients have undergone laparoscopic rectopexy. The median age was 71 years (52–89), and male:female ratio was 27:2. One procedure had to be converted to open due to ventilatory difficulties. The mean operative time was 95 minutes (50–190). The mean hospital stay was 5 days (4–15). There was no mortality in this series. Morbidity included incisional hernia through a port hole (n=1), extraperitoneal haematoma (n=1), and urinary tract infection with retention (n=1). In conclusion, laparoscopic abdominal rectopexy is a safe and effective technique in the management of rectal prolapse.Presented at the annual meeting of the Society of American Gastrointestinal Endoscopic Surgeons (SAGES), Nashville, TN, 18–19 April 1994     

Transsacral rectopexy for recurrent complete rectal prolapse

The aim of this study was to examine the functional outcome of transsacral rectopexy performed with Dexon mesh for recurrent complete rectal prolapse. Anorectal function was assessed by anorectal manometry and defecography, before and from 1 year after surgery in five patients who were followed up for 1–3 years. The fecal incontinence score recovered from a preoperative mean score of 3.8 to a postoperative mean score of 1.2, and constipation was improved in four patients (80%). The straining anorectal angle (S-ARA), measured by defecography, improved from a preoperative value of 120.6°±6.9° to a postoperative value of 98.5°±3.5° (P<0.05), and the perineal descent (PD) improved from a preoperative value of 16.2±2.5 cm to a postoperative value of 8.1±1.3 cm (P<0.05). The maximal resting pressure (MRP) increased from a preoperative value of 20.5±3.7 cmH₂O to a postoperative value of 40.5±4.8 cmH₂O (P<0.05). These findings indicate that transsacral rectopexy with Dexon mesh can achieve good control of recurrent complete rectal prolapse.     

Functional results after laparoscopic rectopexy for rectal prolapse

We investigated the functional results after laparoscopic rectopexy for rectal prolapse in 29 patients at least 12 months postoperatively. Twenty patients were evaluated completely pre- and postoperatively (median 22 months postoperatively, range 12 to 54 months). Six patients were interviewed by telephone, two patients were lost to follow-up, and one patient died of causes unrelated to rectal prolapse. Patients underwent a proctologic examination, anoscopy, rigid sigmoidoscopy, fluoroscopic defecography, and anorectal manometry pre- and postoperatively, and an additional standardized interview postoperatively. Anorectal manometry showed a significant increase in maximum anal resting and squeeze pressures postoperatively (resting pressure 72 ±8 vs. 95 ±13 mm Hg, pre- vs. postoperatively; P = 0.046; squeeze pressure 105 ±17 vs. 142 ±19 mm Hg, pre- vs. postoperatively; P = 0.035), and continence improved postoperatively (Wexner incontinence score 6.0 ±1.0 vs. 3.9 ± 0.8 pre- vs. postoperatively, P = 0.02). Twenty (77%) of 26 patients were satisfied with the operative result, but functional morbidity was observed in four patients, with two patients complaining of severe evacuation problems. Rectal prolapse recurred in one patient 42 months postoperatively (recurrence rate 1 [3.8%] of 26 patients). Functional results were very similar to those obtained after open rectopexy, with symptoms of prolapse and incontinence improved in the great majority of patients. Presented at the Fortieth Annual Meeting of The Society for Surgery of the Alimentary Tract, Orlando, Fla., May 16–19, 1999.     

Triple suspension rectopexy for complete rectal prolapse.

Twenty-eight patients with complete rectal prolapse were treated by a three-level triple suspension abdominal rectopexy with no recurrence and with improvement of rectal function. Rectal suspension was effected by three steel wire slings.     

腹腔镜直肠悬吊固定术治疗直肠重度脱垂

目的探讨腹腔镜直肠悬吊固定术治疗直肠脱垂的临床应用价值。方法1998年3月至2007年2月,对4例完全性直肠脱垂患者进行了腹腔镜直肠悬吊固定术。1例采用缝合固定法,将直肠后壁分离、提高,用丝线缝闭直肠前陷凹,并将直肠后壁悬吊固定于骶骨岬前筋膜上,再将乙状结肠缝合固定在左侧腰大肌筋膜。3例采用网片固定法,将直肠游离到肛提肌水平,用1张6cm×9cm的T字型聚丙烯网片置于直肠后方,网片下缘在肛提肌水平环绕直肠,在直肠前方用丝线缝合网片和直肠浆肌层,再将网片上端在直肠后用疝修补钉夹固定于骶骨岬前筋膜,缝合关闭盆底腹膜。再将乙状结肠缝合固定在左侧腰大肌筋膜。结果4例患者手术均顺利,无中转开腹者。手术时间92.5(80-100)min,出血量6.5(5～10)ml。无并发症发生。术后尿失禁和肛门失禁的症状缓解,术后随访2个月至3年均未见复发与便秘出现。结论腹腔镜下行腹腔镜直肠悬吊固定术创伤小、恢复快和安全有效。     

直肠脱垂患者微创手术的效果研究

目的:探讨腹腔镜直肠补片悬吊固定术治疗直肠脱垂患者的临床效果,为其研究应用提供可参考的依据。方法:选择50例直肠脱垂患者作为研究对象,采用随机数字法平均分为腹腔镜组与开腹组,分别行腹腔镜直肠补片悬吊固定术(腹腔镜组)与开腹直肠补片悬吊固定术(开腹组)。对比两组患者的临床疗效。结果:腹腔镜组术中出血量、术后排气时间及住院时间均明显少于开腹组,差异有统计学意义(P0.05)。术后腹腔镜组C反应蛋白、白介素-6、肿瘤坏死因子-α水平均低于开腹组,差异有统计学意义(P0.05)。腹腔镜组自我效能总分、症状管理自我效能、共性管理自我效能得分高于开腹组,差异有统计学意义(P0.05)。结论:腹腔镜直肠补片悬吊固定术治疗直肠脱垂具有更好的临床疗效及安全性,可更好地提高患者的自我效能,值得临床推广应用。     

Clinical results of abdominal rectopexy for rectal prolapse.

Abdominal Marlex-mesh rectopexy was used for surgical treatment of rectal prolapse in 54 consecutive patients. Anal incontinence was observed in 43 patients (80%) before surgical treatment. The degree of anal incontinence was more severe in women as compared with men. Operative treatment corrected the pathologic anatomy effectively as only one recurrent prolapse developed. At the follow-up examination three patients had symptomless anal mucosal prolapse during maximal straining. 75% of the incontinent patients regained continence for faeces and the rest had some improvement in continence. Seventeen patients (31%) had postoperative constipation, that required lactulose treatment. In conclusion, abdominal Marlex-mesh rectopexy can be recommended as safe and effective treatment for rectal prolapse, despite some patients developing constipation and some remaining incontinent.     

Sutured posterior abdominal rectopexy with sigmoidectomy compared with Marlex rectopexy for rectal prolapse

Two treatment policies for rectal prolapse were prospectively assessed between April 1986 and January 1989. Sixteen patients had a Marlex mesh posterior rectopexy alone and 13 underwent a sigmoidectomy combined with a sutured posterior rectopexy. Preoperative and post-operative assessment included manometry, a saline infusion test and video-proctography. Hospital stay, control of prolapse and complications were comparable in both groups. Restoration of continence occurred in nine of the 12 incontinent patients after Marlex rectopexy, compared with six of nine after sutured rectopexy and sigmoidectomy. Constipation persisted in three patients who were constipated before operation and in four of 13 who had previously normal bowel habits became constipated after Marlex rectopexy; constipation persisted in one of five previously constipated patients while none with previously normal bowel habits became constipated after sutured rectopexy and sigmoidectomy. Sigmoidectomy combined with sutured rectopexy was safe and as efficient as Marlex rectopexy in prolapse control and improvement of continence; significantly fewer patients were constipated (one of 13) after sigmoidectomy than following rectopexy alone (seven of 16). A randomized trial now seems justified.     

Systematic review on ventral rectopexy for rectal prolapse and intussusception

Objective This systematic review assesses the effectiveness of ventral rectopexy (VR) surgery for treatment of rectal prolapse (RP) and rectal intussusception (RI) in adults. Method MEDLINE, EMBASE, Scopus and other relevant databases were searched to identify studies. Randomized controlled trials or nonrandomized studies with more than 10 patients receiving ventral mesh rectopexy surgery were considered for the review. Results Twelve nonrandomized case series studies with 728 patients in total are included in the review. Seven studies used the Orr‐Loygue procedure (VR with posterior rectal mobilization to the pelvic floor) and five studies used VR without posterior rectal mobilization. Overall weighted mean percentage decrease in faecal incontinence (FI) rate was 45%. The weighted mean percentage decrease in constipation rate was 24%. Weighted mean recurrence rate was 3.4%. Conclusions There are limitations in published literature on VR. The available data indicate that VR has low recurrence and improves FI in patients suffering from these conditions. There is a greater reduction in postoperative constipation if VR is used without posterior rectal mobilization.     

Long-term outcome of laparoscopic ventral rectopexy for total rectal prolapse

BACKGROUND: Postoperative constipation is a common problem with most mesh suspension techniques used to correct rectal prolapse. Autonomic denervation of the rectum subsequent to its complete mobilization has been suggested as a contributory factor. The aim of this study was to assess the long-term outcome of patients who underwent a novel, autonomic nerve-sparing, laparoscopic technique for rectal prolapse. METHODS: Between 1995 and 1999, 42 patients had laparoscopic ventral rectopexy for total rectal prolapse. The long-term results after a median follow-up of 61 (range 29-98) months were analysed. RESULTS: There were no major postoperative complications. Late recurrence occurred in two patients. In 28 of 31 patients with incontinence there was a significant improvement in continence. Symptoms of obstructed defaecation resolved in 16 of 19 patients. During follow-up, new onset of mild obstructed defaecation was noted in only two patients. Symptoms suggestive of slow-transit colonic obstipation were not induced. CONCLUSION: Laparoscopic ventral rectopexy is an effective technique for the correction of rectal prolapse and appears to avoid severe postoperative constipation. The ventral position of the prosthesis may explain the beneficial effect on symptoms of obstructed defaecation.     

Clinical and functional results of abdominal rectopexy for complete rectal prolapse

Between 1977 and 1987, 53 patients underwent polyvinyl alcohol sponge rectopexy for complete rectal prolapse. The mean follow-up period was 36.7 months. Full thickness prolapse recurred in two patients (3.8 per cent). Infection around the prosthesis and faecal impaction developed in two patients each. Continence improved significantly after operation, particularly in those under 70 years of age (P = 0.028, chi 2 test) and nulliparous women (P = 0.026, chi 2 test). Bowel function was generally unchanged after rectopexy; in particular only eight patients (15 per cent) had significant postoperative constipation.     

经腹直肠补片悬吊固定术在成人完全性直肠脱垂治疗中的应用

目的 探讨经腹直肠补片悬吊固定术治疗成人完全性直肠脱垂的疗效.方法 对11例接受经腹直肠补片悬吊固定术治疗的成人完全性直肠脱垂（Ⅱ～Ⅲ度）患者的临床资料进行回顾性分析.结果 本组11例患者手术顺利,手术时间1.8～2.6 h.术中出血50～300 ml.术后除1例患者出现尿潴留外,其余均未出现并发症.全组患者均一期愈合,平均住院时间14.5 d.术后经1～3年的随访,未出现直肠再次脱垂,肛门功能恢复良好,排粪通畅.结论 经腹直肠补片悬吊固定术治疗成人完全性直肠脱垂操作简便、并发症少、复发率低,是一种安全有效的方法.     

Successful treatment of rectal prolapse by laparoscopic suture rectopexy

BACKGROUND: A wide variety of procedures are used for management of rectal prolapse. The purpose of this study was to evaluate the results of laparoscopic suture rectopexy in the treatment of this condition. METHODS: From May 1991 to May 1998, 32 consecutive patients were treated by laparoscopic suture rectopexy. In four of them, an additional sigmoid colectomy was performed for refractory constipation or redundant large bowels. The clinical data were analyzed. RESULTS: Of our 32 patients, 27 were female and five were male. The median age was 51.5 years (range, 20-87). The median operative time was 150 min (range, 90-300), and the median hospital stay was 5 days (range, 2-20). There were no operative mortalities. Three postoperative complications required reoperations for bowel obstructions. At a median follow-up of 33 months (range 3-78), there were two complete recurrences. CONCLUSIONS: Our experience indicates that laparoscopic suture rectopexy, with and without sigmoid colectomy, is safe, feasible, and effective for the treatment of rectal prolapse.     

Laparoscopic suture rectopexy for rectal prolapse in a 22-month-old child

We present the case of a 22-month-old female child who presented with severe recurrent rectum prolapse. The patient was successfully managed using the laparoscopic simple suture rectopexy approach with 5-mm instruments employing two 3-0 nonabsorbable sutures on either side of the rectum to secure it to the presacral fascia. There was no blood loss, and the procedure was completed without complication. The child was followed up for a period of 24 months with good results.     

Resection rectopexy for external rectal prolapse reduces constipation and anal incontinence.

BACKGROUND AND AIMS: The main aim was to examine constipation and anal incontinence in patients before and after resection for external rectal prolapse. MATERIAL AND METHODS: Twenty patients had ligament preserving suture rectopexy and sigmoid resection (resection rectopexy) for external rectal prolapse by laparoscopic (n = 15) or open (n = 5) technique during 2001-2005. They were prospectively evaluated for constipation and anal incontinence using validated incontinence and KESS-constipation scores. RESULTS AND CONCLUSIONS: Constipation score was significantly reduced from mean 7.7 (5.4-9.9) to 4.5 (2.5-6.4) after median 4 months (1-19) and to 4.3 (2.2-6.3) after median 17 months (4-51). Six and four patients were constipated preoperatively and 17 months postoperatively, respectively. The four symptoms feeling incomplete evacuation of stool, minutes in lavatory per attempt, use of enemas/digitation and painful evacuation effort were significantly reduced, whilst stool consistency increased. Fourteen patients (70%) had anal incontinence. Corresponding and significant reduction in their scores were from mean 12.5 (9.4-15.5) to 5.1 (2.1-8.1) and to 3.6 (1.3-5.9). Incontinence was improved in 13 and unaltered in one patient(s). Two patients with worse outcome had increased stool consistency and constipation scores. Resection rectopexy for rectal prolapse reduced anal incontinence and constipation.     

Abdominal rectopexy and sigmoid resection (Frykman-Goldberg operation) for rectal prolapse

Transabdominal posterior rectopexy with resection of the redundant left colon (Frykman-Goldberg operation) was performed on 48 selected patients with complete rectal prolapse. Uterine suspension was also performed on most of the women. The 30-day mortality rate was 2.1%. Prolapse recurred in 4 (9%) of the 45 patients followed up for 1-10 (mean 4.3) years. There were no complications attributable to bowel resection or anastomosis. Adequate data on both preoperative and postoperative anal function and bowel habit were available in 41 cases. All but two of the 32 patients with associated incontinence experienced improved anal control after the operation (9 regained normal continence). Bowel habit improved in 23 patients (56%), especially in those with chronic constipation. No patient reported increased problems of bowel management. The operation does not involve the risks associated with implantation of foreign material and can be especially beneficial for constipated patients with rectal prolapse who are fit for major abdominal surgery.