Ajay H Bhandarwar, MS, Priyank D Kothari, Amol N Wagh, MS, Saurabh S Gandhi, MS, Chintan B Patel, MS, Eham L Arora. Grant medical college Mumbai
Introduction: Complete rectal prolapse is a full thickness ,circumferential ,true intussuseption of the rectal wall which protrudes from the anus and is visible externally caused by weakening of ligaments and muscles that hold the rectum in place. More than 50% of the patients with prolapse have incontinence and 15-65% have constipation which makes it socially and medically debilitating. Patients with rectal prolapse have markedly impaired rectal adaptation to distension.Laparoscopic rectopexy is a mimimally invasive technique which involves fixing the rectum to the sacrum and surrounding structures using either mesh or sutures until it becomes fixed by scar tissue.Laparoscopic mesh and suture rectopexy .
Materials and Methods: Patients of complete rectal prolapse(CPR) fit for surgery aged 25-75 were selected from our tertiary care institution.All patients underwent anorectal manometry , defecography, colonoscopy and barium enema. Patients having normal sphincter and colonoscopy were included.Detailed history of constipation and incontinence(celeveland clinic faecal incontinence scores) was taken . After this screening 48 patients underwent laparoscopic mesh rectopexy and suture rectopexy. For Patients in mesh rectopexy group, synthetic composite meshes were used and unabsorbable sutures were used in the suture rectopexy group to hitch up the rectum to the sacrum. Patients were followed up for 2 years and both groups were compared in terms of mean operative time , first passage of stools, post operative pain, improvement in incontinence(compared to pre operative scores), constipation and post operative complications. No recurrences were reported in both groups at 2 year follow up.
Results: Out of the 25 patients who underwent mesh rectopexy 2 patients had mesh related complications , with one having mesh migration and the other having mesh erosion both requiring re operation. One patient in the 2nd group(sutured) required converting to open due to severe adhesions Mesh rectopexy patients had a mean operative time of 124±10 minutes and suture rectopexy group had mean time of 96±10 minutes.12 out of 16 patients(75%) had improvement in constipation in the suture rectopexy group compared to only 05/15 patients(33%) in the mesh rectopexy group. Post-op flatus and bowel moments were earlier with the suture rectopexy group. There was no significant difference in terms of improvement in incontinence between the 2 groups.
Conclusion: Laparoscopic suture rectopexy has a shorter operative time , and significantly better improvement in the constipation compared to mesh rectopexy without the additional complications and cost related to mesh rectopexy without significant difference in recurrence rates.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80033
Program Number: P230
Presentation Session: Poster (Non CME)
Presentation Type: Poster