Surgical technique and outcome of laparoscopic rectopexy for rectal prolapse

Junichi Hasegawa, MD, Shingo Noura, MD, Masaki Hirota, MD, Tae Matsumura, MD, Chikato Koga, MD, Chizu Kameda, MD, Masahiro Murakami, MD, Ryouhei Kawabata, MD, Masato Yoshikawa, MD, Junzo Shimizu. Department of Surgery, Osaka Rosai Hospital

Aim: The aim of this study is to examine the clinical and functional outcome of laparoscopic rectopexy in a consecutive series of elderly patients with full-thickness rectal prolapse.

Method: Sixteen patients (all women; median age 79 years, rage 72-92 years, median ASA Grade 2.) underwent laparoscopic rectopexy to treat rectal prolapse between April 2013 and August 2015. The median prolapse size was 10 [5-20] cm, and five patients (31.3%) had previous prolapse surgery. Five patients (31.3%) had undergone pervious pelvic surgery, the most common of which was hysterectomy, performed for 4 patients. Symptomatic and functional data were collected prospectively before and after surgery. Anorectal physiology was assessed by manometry (maximum resting pressures, MRP, and maximum squeeze pressure, MSP).

Results: Laparoscopic rectopexy with posterior mesh fixation were performed in 14 patients and suture rectopexy in one. Conversion to open technique was needed in one patient that underwent the suture rectopexy with sigmoidectomy. One patient who could not undergo bowel preparation due to dementia, was complicated with stercoraceous perforation of the rectum three days after operation and died. Small bowel obstruction was conservatively treated in one patient. Anal incontinence improved in 5 of 6 patents (83%). Six patients (37.5%) were constipated after surgery. MRP and MSP had improved after surgery.: MRP from a mean of 19.6±3.1 mmHg (rage 15-25 mmHg) before surgery to 24.0±13.4 mmHg (10-50 mmHg) at 1month and 28.3±12.4 mmHg (10-43 mmHg) 6 months after surgery; MSP from 127.1±72.4 (60-277 mmHg) before surgery to 143.4±80.1 mmHg (75-307 mmHg) at 1month and 173.6±90.7 mmHg (93-359 mmHg) 6 months after surgery. At 10 months, none experienced persistence or recurrence of rectal prolapse.

Conclusion: Laparoscopic rectopexy as treatment for rectal prolapse resulted in an improvement in anal incontinence and satisfactory control of prolapse.