Laparotomic vs. laparoscopic rectopexy in complete rectal prolapse.
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.
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ABSTRACT: Siden 2001 har Gastrokirurgisk avdeling ved Universitetssykehuset Nord-Norge (UNN) rutinemessig utført laparoskopisk rectopexi med polypropylennett på pasienter med tilstanden indre rektalt prolaps. Som en del av avdelingens kvalitetskontroll har det vært ønskelig å se på de funksjonelle resultatene av dette inngrepet, samt sammenligne om det er forskjell i resultat mellom pasienter som er operert på denne måten og pasienter som er operert med laparotomi for samme tilstand. Denne oppgaven presenterer tilstanden indre rektalt prolaps, samt gjennomgår behandlingsresultatene for pasienter operert ved UNN for indre rektalt prolaps, laparoskopisk eller med laparotomi, i perioden 30/01/02 – 01/02/07. Resultatene er basert på en skriftlig spørreundersøkelse som ble sendt ut til alle pasientene. Oppgaven er således en kombinasjon av et litteraturstudium og en prevalensundersøkelse. Det ble funnet at 61% av pasientene hadde liten eller ingen effekt av inngrepet, mens 39% var fornøyde. Det ble funnet en særlig tendens til misfornøydhet blant pasienter som oppga obstipasjon som dominerende preoperativt symptom. De funksjonelle resultatene er basert på en subjektiv vurdering fra hver enkelt pasient gjennom spørreskjemaundersøkelsen. Undersøkelsen har avdekket mangel på bruk av preoperative symptomscore-skjema. Derfor har det vært vanskelig å trekke sikre konklusjoner om symptomatisk effekt av inngrepet fordi det mangler sammenligningsgrunnlag med pasientenes angivelse av symptomene preoperativt. Det var svært få observasjoner blant pasientene operert med laparotomi og dermed vanskelig å trekke noen konklusjon om hvorvidt laparoskopisk teknikk gir bedre resultat enn laparotomi for denne typen operasjon. Pasienttilfredsheten tenderer imidlertid til å være lik i de to gruppene. De som ble operert laparoskopisk hadde kortere liggetid enn de som ble laparotomert. Universitetssykehuset Nord-Norge (UNN)
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ABSTRACT: Perineal approaches are considered to be the 'gold standard' in treating elderly patients with external rectal prolapse (ERP) because morbidity and mortality with perineal approaches are lower compared with transabdominal approaches. Higher recurrence rates and poorer function are tolerated as a compromise. The aim of the present study was to assess the safety of laparoscopic ventral rectopexy (LVR) in elderly patients, compared with perineal approaches. The prospectively collected databases from two tertiary referral pelvic floor units were interrogated to identify outcome in patients of 80 years of age and older with full-thickness ERP treated by LVR. The primary end-points were age, American Society of Anesthesiology (ASA) grade, mortality, and major and minor morbidity. Secondary end-points were length of stay (LOS) and recurrence. Between January 2002 and December 2008, 80 [median age 84 (80-97) years] patients underwent rectopexy. The mean ± standard deviation ASA grade was 2.44 (± 0.57) (two patients were ASA grade I, 42 patients were ASA grade II, 35 patients were ASA grade III and one patient was ASA grade IV). The median LOS was 3 (range 1-37) days. There was no mortality, and 10 (13%) patients had complications (one major and nine minor). At a median follow-up of 23 (2-82) months, two (3%) patients had developed a recurrent full-thickness prolapse. LVR is a safe procedure for using to treat full-thickness ERP in elderly patients. Mortality, morbidity and hospital stay are comparable with published rates for perineal procedures, with a 10-fold lower recurrence.Colorectal Disease 02/2010; 13(5):561-6. · 2.08 Impact Factor
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ABSTRACT: Numerous surgical options exist for the correction of rectal prolapse, with the optimal choice remaining controversial. The laparoscopic approach has proved to be popular and effective. Concern exists about nonresectional rectopexy in the form of intractable postoperative constipation. The authors present their experience with nonresectional laparoscopic suture rectopexy. All patients presenting with a full-thickness rectal prolapse between August 1994 and August 2009 who proved to be fit for a general anesthesia were offered a laparoscopic repair. Data were entered into a database, then prospectively and retrospectively analyzed. The data recorded included patient demographics, preoperative symptoms, conversion to open procedure, length of hospital stay, and postoperative complications. Preoperative Cleveland Clinic Incontinence Scores (CCIS) were calculated. Follow-up evaluation was by telephone questionnaire. Postoperative constipation, recurrence, and CCIS were noted. The series included 72 patients (71 women, 98%) with a median age of 72 years (range, 24-88 years). The median follow-up period was 48 months (range, 5-144 months). A total of 13 patients were lost to follow-up evaluation. The median operating time was 98 min (range, 35-200 min), and the median hospital stay was 2 days (range, 1-29 days). Three conversions to open procedure (5%) were performed. The median preoperative CCIS was 9.54 compared with 4.44 postoperatively (p = 0.024). The complications included one postoperative bleed requiring transfusion, one port-site abscess requiring incision and drainage, one postoperative retention of urine, and one chest infection. Postoperatively, 10 patients (17%) reported occasional constipation not requiring intervention, and an additional 10 patients (17%) reported more severe constipation, all managed successfully with regular laxatives. The patients followed up experienced six recurrences (9%). No postoperative deaths occurred. Laparoscopic abdominal suture rectopexy without resection is safe and effective for the treatment of full-thickness rectal prolapse.Surgical Endoscopy 04/2011; 25(4):1062-4. · 3.43 Impact Factor