Tokihito Nishida, PhD, Hajime Ikuta, PhD, Kunio Yokoyama, PhD, Takuya Kudo, MD. Department of Surgery, Kasai City Hospital, Hyogo, Japan
Background: For the complete rectal prolapse (basically longer than 3cm), we thought sling rectopexy was most reasonable to hang up and fix the rectum, which drooped down and prolapsed due to the relaxation of supporting tissue. We considered Ripstein method had enough fixed power of rectum to sacrum. However, complications of rectal stenosis, constipation, mesh infection and mesh penetration were reported. Therefore, we modified Ripstein method to conquer such complications.
Aim: A prospective study beyond the randomized control trial (RCT) between our modified (m)-Ripstein method and m-Wells methods was performed to evaluate feasibility and efficacy of our m-Ripntein method.
Materials and Methods: From December 2007 to August 2017, 79 rectopexies for complete rectal prolapse were assigned to RCT. To prevent the complication of original Ripstein method, we devised to set the horizontal length of T style BARDTM mesh up to almost 1.2 fold of rectal circumference for loose fit, and prolong the vertical length of the mesh to almost 2 fold of the original for straight fit. Mesh was fixed to rectum with Endo Universal StaplerTM and to sacrum with AbsorbaTackTM. When each 25 cases were registered to RCT, second recurrence of m-Wells method occurred. We stopped m-Wells method until the cause would be clear and continued m-Ripstein method to 51 cases. After the cause of recurrence by m-Wells method was revealed, it was resumed to 28 cases.
Results: Patient’s characteristics (average value) in m-Ripstein 51 cases vs. m-Wells 28 cases were not significantly different; age 79.1 vs. 78.9-year-old, female 86.3 vs. 85.7%, BMI 21.7 vs. 21.1, length of prolapse 4.7 vs. 4.3cm, comorbidities number per patient 4.4 vs.4.8 and ASA-PS 2.6 vs. 2.6. In clinical outcomes (average value), operative time was 164 vs. 143 minutes (P=0.0318) and the others; blood loss 33 vs. 11 grams, intraoperative accident 18 vs. 7%, postoperative complication 9.8 vs. 3.6%, mesh infection/morbidity 0 vs. 0 %, meal start 1.9 vs. 1.9POD, postoperative constipation 14 vs. 14%, postoperative fecal incontinence 7.8 vs. 0%, postoperative urinary incontinence 5.9 vs. 0%, postoperative stay 9.4 vs.9.0 days, follow up interval 39 vs. 31 months and recurrence rate 0 vs. 7.1 % were not significantly different.
Conclusion: Primary evaluation item of recurrence rate were not significantly different. Secondary evaluation items of postoperative constipation, fecal incontinence and urinary incontinence were not significantly different between two groups. Our m-Ripstein method was feasible and showed good outcome especially in recurrence.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87567
Program Number: P223
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster
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