Premium
CR06
*LAPAROSCOPIC ANTERIOR RECTOPEXY FOR EXTERNAL PROLAPSE IS SAFE IN THE ELDERLY AND MAKES PERINEAL PROCEDURES ALMOST OBSOLETE
Author(s) -
Akbar A.,
Wijffels N.,
Cunningham C.,
Dixon A.,
Lindsey I.
Publication year - 2009
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/j.1445-2197.2009.04915_6.x
Subject(s) - medicine , constipation , bowel function , rectal prolapse , cohort , surgery , fecal incontinence , pelvic floor , rectum
Purpose: Perineal procedures, despite high recurrence (pooled published series 18%) and poor function, are gold standard for external rectal prolapse (ERP) in the elderly for safety. Abdominal rectopexy has lower recurrence (<5%), but performed posteriorly induces constipation in 50% and open has higher morbidity. Laparoscopic anterior rectopexy (LAR) overcomes these limitations, improving constipation with low recurrence. We aimed to assess efficacy and safety of LAR for ERP in the elderly. Methodology: Data on LAR for ERP >80 from 2 tertiary colorectal pelvic floor services in Oxford and Bristol were collected prospectively and analysed. End‐points were mortality, morbidity, length of stay (LOS). A subgroup was analysed for change in bowel function (Wexner constipation score and Faecal Incontinence Severity Index [FISI]). A comparison was made with a cohort of patients <80 years. Results: 81 patients (1 Delorme's in this period) 80 years or more (28% of total) were compared with 149 patients under 80 (98% vs. 86% female, age median 84 vs. 60 years, range 80–97 vs. 16–79 years). 30‐day mortality (0% vs. 0%), morbidity (11% vs. 3%+), LOS (2 vs. 2 days) and recurrence (2% vs. 0%) was acceptably low and similar in both age cohorts. Functional results were excellent, both cohorts showing improvement in constipation (median Wexner pre‐op 10 to post‐op 3 vs. 10 to 4, new‐onset constipation negligible) and incontinence (median FISI 31 to 0 vs. 34 to 8, resp.). Conclusions: LAR is safe and can be offered to all fit elderly ERP patients. Perineal procedures should be restricted to the very frail.