Introduction Laparoscopic ventral mesh rectopexy (LVMR) repairs rectal prolapse and rectocoele by an autonomic nerve-sparing rectal dissection, using mesh reinforcement. The aim of this retrospective series was to assess functional outcomes of laparoscopic VMR and compare with an historical control group having had open resection rectopexy.
Method Between 2012 and 2015, 64 patients had LVMR for rectal prolapse, functional obstructed defaecation (FOD) caused by rectocoele and/or faecal incontinence (FI). 31 out of 64 patients underwent preoperative imaging by MRI defaecating proctogram. Biological mesh was used in 51 out of 64 (80%) patients. We reviewed electronic patient records for outcomes and telephoned patients for further review of symptoms after surgery. Follow-up ranged from 1–33 months, median 12 months. Outcomes were also analysed in 68 patients who had open resection rectopexy between 1999 and 2009 (range 5–14 years, median 8 years).
Results The conversion rate to open VMR was 7 out of 64 (11%) patients, due to adhesions from previous surgery. In this series of laparoscopic VMR, a total of 4 out of 64 patients required re-intervention, 2 for complications and 2 for technical failure (ie. early recurrent rectal prolapse and rectocoele). At 5 months there were no infections, fistulae or pain complications. In all patients with FI (n = 32), there was improvement in symptoms at initial follow-up. FOD resolved in 43 out of 44 patients. Outcomes from open resection rectopexy include FI (11 patients), constipation (8), FOD due to rectocoele (7), adhesional small bowel obstruction (7, of which 3 required laparotomy), uterovaginal prolapse (6), recurrent rectal prolapse (4) and incisional hernia (1).
Conclusion Laparoscopic VMR is an effective technique for repairing rectocoele, rectal prolapse, and tricompartmental pelvic floor decent. It has a low complication rate with high resolution of symptoms at early follow-up (median 12 months). The longer term follow-up for open resection rectopexy suggested a higher level of recurrent prolapse, FI and FOD. Longer follow-up data on laparoscopic VMR patients is underway. This series of laparoscopic VMR repair for rectal prolapse and/or rectocoele has demonstrated early improvement in functional outcome overall and when compared with historical open resection rectopexy operations.
Disclosure of interest None Declared.
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