Laparoscopic ventral mesh rectopexy in the management of solitary rectal ulcer syndrome: a cause for optimism?

Aim The treatment of solitary rectal ulcer syndrome ( SRUS ) is notoriously difficult. Laparoscopic ventral mesh rectopexy ( LVMR ) is a nonresectional technique for patients with full thickness external rectal prolapse and internal prolapse with obstructed defaecation syndrome ( ODS ), features associated in the pathogenesis of SRUS . Our aim was to assess the short‐ and long‐term efficacy of LVMR in treating SRUS . Method Forty‐eight patients with SRUS who underwent LVMR over a 15‐year period (December 1996 to July 2012) were identified from a prospectively maintained electronic database. Results Forty‐eight patients, 38 (79%) women, median age 43 (18–80) years, median body mass index 26 (21–40) kg/m 2 underwent LVMR for SRUS after initial biofeedback. The median follow‐up was 33 months (95% CI 31–55, range 1–186 months); 52% were followed for more than 3 years and 13 (27%) for more than 5 years. Five (10%) had relapsed following a response to stapled transanal rectal resection ( STARR ; 10 additional patients have had a continued response to STARR ). Eleven (23%) had intermittent reducible external prolapse. Epithelial ulcer healing was reported in all patients at 3 months. The ODS scores improved by 68% ( P  <   0.0001) and quality of life ( Q o L ; Birmingham Bowel and Urinary Symptoms Questionnaire‐22) scores improved by 45% ( P  <   0.0001). There was a significant improvement in bowel visual analogue scale ( VAS ) scores at 3 and 12 months ( P  =   0.0007). Sustained improvement in Q o L and VAS scores was maintained at 2 years and continued in the 52% followed up for between 3 and 15 years. There were four (8%) symptomatic ODS recurrences: posterior rectal wall prolapse successfully treated by STARR (3) and one symptom free for 2 years following a temporary loop ileostomy. There were two recurrences (4%). Conclusion LVMR appears to provide a sustained improvement in Q o L , VAS and patient satisfaction in patients with SRUS . Morbidity, recurrence and safety profiles are low.