Laparoscopic resection rectopexy for rectal prolapse: a single-center study during 16 years

• Published in: Surgical endoscopy Vol. 24; no. 10; pp. 2401 - 2406
• Main Authors: Laubert, Tilman, Kleemann, Markus, Schorcht, Alexander, Czymek, Ralf, Jungbluth, Thomas, Bader, Franz G., Bruch, H.-P., Roblick, Uwe J.
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01.10.2010; Springer; Springer Nature B.V
• Subjects: Abdomen; Abdominal Surgery; Anus; Biological and medical sciences; Colorectal surgery; Constipation; Digestive system. Abdomen; Endoscopy; Female; Gastroenterology; Gastroenterology. Liver. Pancreas. Abdomen; Gynecology; Hepatology; Humans; Intestinal obstruction; Investigative techniques, diagnostic techniques (general aspects); Laparoscopy; Laparoscopy - adverse effects; Male; Medical sciences; Medicine; Medicine & Public Health; Mesentery; Middle Aged; Other diseases. Semiology; Patients; Postoperative Complications; Proctology; Questionnaires; Rectal Prolapse - pathology; Rectal Prolapse - surgery; Rectum; Rectum - surgery; Reoperation; Stomach, duodenum, intestine, rectum, anus; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Treatment Outcome; Recurrence; Rectal prolapse; Laparoscopy; Resection rectopexy; Follow-up; Endoscopic surgery; Relapse; Rectopexy; Treatment; Digestive diseases; Intestinal disease; Endoscopy; Anorectal disease
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s00464-010-0962-9

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.