Introduction To compare short and medium-term outcomes of surgery for external full thickness rectal prolapse at a single university institution, where Delorme’s procedure, laparoscopic posterior suture rectopexy and laparoscopic ventral mesh rectopexy are performed.
Method Patients were identified from a prospective database. Consecutive patients undergoing surgery for rectal prolapse over a five year period between 2009 and 2014 were included. Patient data including age, gender, type of operation, hospital stay, complications, readmissions, duration of follow up, recurrence and mortality were recorded. The type of surgery was selected after careful discussion with each patient including the potential risks and complications specific to each of the three surgical procedures. Cases were also discussed at a pelvic floor multidisciplinary team meeting.
Results During the study period, 77 patients underwent surgery with a median age of 74 years (range 18–90). A total of 69 (89.6%) were female. There were 20 (25.9%) patients who had previously undergone surgery for prolapse. A total of 20 (26%) Delorme’s procedures, 15 (19%) laparoscopic posterior suture rectopexies and 42 (55%) laparoscopic ventral mesh rectopexies were performed. The median (range) patient age was 79 (48–90) years, 74 (30–89) years and 79 (18–88) years respectively. Median follow-up was 35 (1–120) months. Recurrence rates were 23.8%, 13.3% and 4.7% respectively. Length of hospital stay was a median (range) of 2 (1–21) days, 3 (1–7) days and 2 (1–7) days respectively. There were no mesh related complications and no 60-day mortality.
Conclusion Multiple operations have been described for rectal prolapse. At our institution, laparoscopic mesh ventral rectopexy had the lowest rate of recurrence with a similar length of hospital stay when compared with the alternatives of Delorme’s procedure and laparoscopic posterior suture rectopexy. Despite this, some patients may still opt for an operation with a higher recurrence rate to avoid potential complications such as mesh erosion. Longer term data is needed to assess these risks and inform patient choice.
Disclosure of interest None Declared.