Procedure and the benefit of laparoscopic suture rectopexy for overt rectal prolaps in comparison with transperineal procedures

Nagahide Matsubara, MD, Kiyoshi Tsukamoto, MD, Mie Yoshimura, MD, Michiko Hamanaka, MD, Naohito Beppu, Naohiro Tomita, MD. Hyogo College of Medicine

INTRODUCTION: Several procedures have been designed and applied to treat overt rectal prolapse. Transperineal procedures, such as Miwa-Gantz, Altemeier and Delorme operations, are associated with less morbidity, but higher rate of recurrence. Transabdominal procedures include a variety of rectopexies with the use of prosthesis or sutures and with or without resection of the redundant sigmoid colon, which are all approached by laparoscopy in recent years. Traditional prosthesis rectopexies are sometimes associated with increased rate of constipation. Resection sutuere-rectopexy seems to be associated with the best functional results, particular in patients with slow transit constipation and diverticular disease, however, risk for suture insufficiency is always the problem for the elderly patients and, thus, must be avoided. We prefer simple suture rectopexy method recently and compared the results of other procedures conducted in our institute.

METHOD AND PROCEDURES: From 1990 to January 2012, 44 patients with rectal prolapse were operated in our institution, including 9 Miwa-Gantz operation, 15 Altemeier method, and 13 rectopexy (11 by laparoscopic and 2 by open procedure). Complications per and postoperative as well as patient satisfaction for laparoscopic rectopexy were assessed.

RESULTS: The mean operative time was 162 min in rectopexy and mean blood loss was 87ml. The postoperative complication rate was 14% corresponding bowel obstruction and recurrence (distance complication). With a mean follow-up of 40.7 months, 86% patients declared themselves satisfied with the intervention.

DISCUSSION AND CONCLUSION: Our results confirm the feasibility of the laparoscopic rectopexy with a quality of life improvement.

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