Laparoscopic Anterior Rectopexy to the Promontory for Full-Thickness Rectal Prolapse in 175 Consecutive Patients: Short- and Long-term Follow-up

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Abstract

BACKGROUND:

There are multiple procedures to treat full-thickness rectal prolapse. No consensus exists as to the best surgical option. All procedures have a significant recurrence rate.

OBJECTIVE:

The aim of this study was to report short- and long-term technical results following laparoscopic removal of the Douglas pouch peritoneum and anterior rectopexy in patients with total rectal prolapse.

DESIGN:

This study is a prospective evaluation of consecutive patients.

SETTINGS:

This investigation was conducted at a single academic colorectal unit.

PATIENTS:

Between May 1996 and June 2009, 175 consecutive patients (17 males) with a mean age of 58 years (range, 16–94) were operated on.

INTERVENTION:

The Douglas pouch peritoneum was excised, 2 synthetic meshes were fixated to the anterior part of the lower rectum with five 4-mm staples and to the promontory with 3 spiked chromium staples, and the peritoneum was closed over the meshes to isolate them from the abdominal cavity.

MAIN OUTCOME MEASURES:

Patients were reviewed at months 1, 6, 12, and then annually. Mortality, morbidity, and recurrence were analyzed. Median follow-up was 74 months (range, 24–181). Recurrence rate was calculated according to the Kaplan-Meier method.

RESULTS:

There was no mortality. Morbidity (5.1%) consisted in temporary brachial plexus palsy in 2 cases, urinary infection in 3 cases, ureteral lesion in 1 patient having had a previous bone graft on the promontory for spondylolisthesis (JJ catheter), and perforation of the small bowel because of adhesions (laparoscopic suture) in 1 case. One patient presented with a rectal erosion at month 9 (transanal removal of the mesh). Two patients presented with a recurrence of the rectal prolapse at months 6 and 24 (recurrence rate of 3% at 5 years) that was treated with anal artificial sphincter in one and redo operation in the other.

CONCLUSION:

Laparoscopic removal of the Douglas pouch peritoneum and rectopexy to the promontory is a safe and efficient procedure to treat full-thickness rectal prolapse.

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