Introduction Laparoscopic ventral mesh rectopexy (LVMR) is gaining wider acceptance. The aim of this study is to present that LVMR can be learnt and safely performed with short term results similar to that of establish centres
Method All patients presented with obstructed defecation (ODS) and rectal prolapse from January 2011 to January 2015 underwent anorectal physiology, defecation proctography, colon transit studies, colonoscopy or sigmoidoscopy as appropriate, pelvic floor MDT and biofeedback. Patients with high grade intussusception who did not respond to laxatives and biofeedback were offered LVMR. Surgical technique was as described by A. D’Hoore et al . and was performed by both authors who are experienced laparoscopic surgeons. We initially used lightweight monofilament polyester mesh (Parietex™) 4 × 20 cm. This was later changed to Titanium coated lightweight polypropylene mesh (TiLENE®) 4 × 20 cm or 4 cm × 18 cm × 1 mm biological mesh (Permacol™) in young patients. Suturing was Intracorporeal and Ethibond Excel®2/0 was used to attach the mesh to the rectum. Vicryl® 2/0 was used for Colpopexy and ProTack™ 5mm for attaching the mesh to the sacral promontory. Data concerning demographics, operative data, complications, length of stay, recurrence and patient reported outcome were gathered from a prospective data base. Data are presented as median, range and proportions.
Results Median age, ASA and BMI were 60.5 (34–78), 2 (1–3), 26.1 (20.4–33.1). Previous pelvic surgery included hysterectomy (35%), Vaginal wall repair (15%) and rectal prolapse surgery (20%). 2 patients had undergone Delorme’s procedure whereas 2 patients had previous laparoscopic suture rectopexy. 60% had Oxford prolapse grades 3/4 and rest were grade 5. Enterocele (25%), Rectocele (40%) and Middle compartment prolapse (5%) were associated. Median operative time was 229 min (175–330). Synthetic mesh was used in 16 patients (Parietex 30%, TiLENE 50%) and Permacol in 4(20%). Colpopexy was performed in 90%. 30 day mortality was zero. There were no conversions and overall complication rate was 10% (1 wound infection and 1 port site hernia). No intraoperative complications, mesh related complications or sexual dysfunction were reported. Median length of stay was 3(2–6). 17 patients (85%) had 6 months or more follow up. Median patient reported outcome for satisfaction was 9.5 on a scale of 1 to 10(2–10). One patient developed recurrence of ODS after 1 year. One patient (Permacol) developed recurrent prolapse as well as anterior and posterior vaginal prolapse after 6 months.
Conclusion We suggest that experienced laparoscopic surgeons can learn and safely perform laparoscopic ventral mesh rectopexy
Disclosure of interest None Declared.
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