Background: Perineal approaches have been preferred for the treatment for full-thickness rectal prolapse in elderly patients despite a higher incidence of recurrence when compared with open abdominal approaches. However laparoscopic rectopexy with or without resection may also be used for elderly patients.
Purpose: Therefore, the aim of this study was to evaluate safety and effectiveness of laparoscopic rectopexy compare to perineal rectosigmoidectomy for full-thickness rectal prolapse in elderly patients.
Methods: Between July 2000 and June 2009, eight consecutive patients (8 female; mean age 71.0, range 65-77 years) with full-thickness rectal prolapse underwent laparoscopic rectopexy. In the same period, 143 patients underwent perineal rectosigmoidectomy. Thirty-five age-matched patients were selected (35 female; mean age 73.8, range 66-79 years).
Results: Three patients (37.5%) in the laparoscopic rectopexy group and 13 patients (37.1%) in perineal rectosigmoidectomy group had previous operation history for rectal prolapse. Mean follow-up period were 7.2 months (range 1.0 ~ 15 months) and 15.9 months (range 0.1 ~ 85.9 months), respectively. In the laparoscopic rectopexy, operation time was longer (116.5 vs 77.4 hours, p < 0.05). But, hospital stay was same in both groups (4.4 vs 4.5 days, p > 0.05). Postoperative complications were one included an incisional hernia in laparoscopic rectopexy group (12.5%) and three (8.6%) included acute renal failure (1), urinary retention (1) and one anastomotic leak in perineal rectosigmoidectomy group.. Recurrences were 2 (25%) in laparoscopic rectopexy group and 4 (11.4%) in perineal rectosigmoidectomy group.
Conclusion: Laparoscopic rectopexy is a safe and feasible procedure in elderly patients with full-thickness rectal prolapse but results in increased operative time, increased postoperative complications, and higher recurrence rate as compared to perineal rectosigmoidectomy. However large randomized trials, with comparative methodology are needed.
Program Number: P168