Laparotomic vs. laparoscopic rectopexy in complete rectal prolapse.

Department of General and Oncologic Surgery, University of Milan, Ospedale Maggiore Policlinico, IRCCS, Milan, Italy.
Digestive Surgery (Impact Factor: 1.47). 01/1999; 16(5):415-9. DOI: 10.1159/000018758
Source: PubMed

ABSTRACT The aim of this study was to compare the functional and clinical results of laparotomic and laparoscopic rectopexy in 2 homogeneous groups of patients with complete rectal prolapse and fecal incontinence.
Between January 1989 and December 1997, twenty-three patients underwent abdominal rectopexy. Thirteen patients (group A, 12 females and 1 male, mean age 57.3, range 22-76 years), and 10 patients (group B, 10 females, mean age 52.3, range 26-70 years) were submitted respectively to either Wells laparotomic or laparoscopic rectopexy by the same surgical team using the same surgical technique and materials. Before the operation a detailed clinical history was collected, and the patients were studied by inspection and digital examination of the anorectum, proctosigmoidoscopy, pancolonic transit time, dynamic defecography, anorectal manometry and anal electromyography. After the operation all patients underwent perineal physiotherapy, external electric stimulation, and perineal biofeedback. Mean follow-up was 37.1 (range 6-90) months in group A and 25.7 (range 6-49) months in group B. Values were compared by chi(2), Mann-Whitney U, and Wilcoxon tests as appropriate. Differences were considered significant at p < 0.05.
In both groups dyschezia and fecal incontinence improved significantly (p < 0.05) after the operation. The basal pressure of the anal sphincter, squeezing pressure and rectoanal reflex improved without significance, and anal-perineal pain was not significantly reduced. In group B the postoperative hospital stay was lower than in group A, with a reduction in costs.
Laparoscopic Wells rectopexy has the same clinical and functional results as laparotomic rectopexy, but with a shorter postoperative hospital stay and lower costs.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: INTRODUCTION: Solitary rectal ulcer syndrome is a condition in which an ulcer occurs in the rectum. There is evidence that solitary rectal ulcer syndrome is associated with rectal prolapse either overt or occult and that stopping complete rectal prolapse may lead to rapid healing of the solitary rectal ulcer. A huge variety of operative techniques have been described in the literature to correct this condition. We present the case of a patient who underwent hand-assisted laparoscopic suture rectopexy for complete rectal prolapse complicated by a solitary ulcer and obstructed defecation. CASE PRESENTATION: A 32-year-old Caucasian woman presented to our institute complaining of having had difficulty with her bowel movements, a rectal prolapse and pain in the anal area for one and a half years. She was checked in hospital for suspected rectal carcinoma, however, the examination revealed rectal ulceration. A diagnosis of complete rectal prolapse complicated by a solitary ulcer and obstructed defecation was established. The symptoms persisted so a hand-assisted laparoscopic suture rectopexy was performed. After six months of follow-up, her bowel movements had improved, she was experiencing no pain and the rectal ulcer had healed. CONCLUSION: A hand-assisted laparoscopic suture rectopexy is a feasible and safe surgical treatment of rectal prolapse with solitary rectal ulcer syndrome, providing complete recovery for patients with solitary rectal ulcer syndrome.
    Journal of Medical Case Reports 01/2013; 7(1):133.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Rectal prolapse continues to be problematic for both patients and surgeons alike, in part because of increased recurrence rates despite several well-described operations. Patients should be aware that although the prolapse will resolve with operative therapy, functional results may continue to be problematic. This article describes the recommended evaluation, role of adjunctive testing, and outcomes associated with both perineal and abdominal approaches.
    Gastroenterology clinics of North America 12/2013; 42(4):837-61. · 2.56 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The aim of our study is to compare the results of laparoscopic mesh vs. suture rectopexy. In this retrospective study, 70 patients including both male and female of age ranging between 20 years and 65 years (mean 42.5 yrs) were subjected to laparoscopic rectopexy during the period between March 2007 and June 2012, of which 38 patients underwent laparoscopic mesh rectopexy and 32 patients laparoscopic suture rectopexy. These patients were followed up for a mean period of 12 months assessing first bowel movement, hospital stay, duration of surgery, faecal incontinence, constipation, recurrence and morbidity. Duration of surgery was 100.8 ± 12.4 minutes in laparoscopic suture rectopexy and 120 ± 10.8 min in laparoscopic mesh rectopexy. Postoperatively, the mean time for the first bowel movement was 38 hrs and 40 hrs, respectively, for suture and mesh rectopexy. Mean hospital stay was five (range: 4-7) days. There was no significant postoperative complication except for one port site infection in mesh rectopexy group. Patients who had varying degree of incontinence preoperatively showed improvement after surgery. Eleven out of 18 (61.1%) patients who underwent laparoscopic suture rectopexy as compared to nine of 19 (47.3%) patients who underwent laparoscopic mesh rectopexy improved as regards constipation after surgery. There were no significant difference in both groups who underwent surgery except for patients undergoing suture rectopexy had better symptomatic improvement of continence and constipation. Also, cost of mesh used in laparoscopic mesh rectopexy is absent in lap suture rectopexy group. To conclude that laparoscopic suture rectopexy is a safe and feasible procedure and have comparable results as regards operative time, morbidity, bowel function, cost and recurrence or even slightly better results than mesh rectopexy.
    Journal of Minimal Access Surgery 01/2014; 10(1):18-22.