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Laparoscopic ventral rectopexy for internal rectal prolapse: short‐term functional results
Author(s) -
Collinson R.,
Wijffels N.,
Cunningham C.,
Lindsey I.
Publication year - 2010
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/j.1463-1318.2009.02049.x
Subject(s) - medicine , rectal prolapse , constipation , fecal incontinence , bowel function , biofeedback , surgery , autonomic nerve , pelvic floor , rectum , physical therapy
Objective Over the last 15 years, posterior rectopexy, which causes rectal autonomic denervation, was discredited for internal rectal prolapse because of poor results. The condition became medical, managed largely by biofeedback. We aimed to audit the short‐term functional results of autonomic nerve‐sparing laparoscopic ventral rectopexy (LVR) for internal rectal prolapse. Method Prospectively collected data on LVR for internal rectal prolapse were analysed. End‐points were changes in bowel function (Wexner Constipation Score and Fecal Incontinence Severity Index) at 3 and 12 months. Analysis was performed using Mann–Whitney U ‐test for unpaired data and Wilcoxon signed rank test for paired data (two‐sided p‐test). Functional outcomes were compared with those achieved previously for external rectal prolapse (ERP). Results Seventy‐five patients underwent LVR (median age 58, range 25–88 years, median follow up was 12 months). Mortality (0%), major (0%) and minor morbidity (4%) were acceptably low. Median length of stay was 2 days. Preoperative constipation (median Wexner score 12) and faecal incontinence (median FISI score 28) improved significantly at 3 months (Wexner 4, FISI 8, both P < 0.0001) and 12 months (Wexner 5, FISI 8, both P < 0.0001). No patient had worse function. Functional outcomes were similar to those for ERP. Conclusion Laparoscopic ventral rectopexy for internal rectal prolapse improves symptoms of obstructed defaecation and faecal incontinence in the short‐term. This establishes proof of concept for a nerve‐sparing surgical treatment for internal rectal prolapse.