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Purpose:Rectal prolapse is commonly seen in patients with significant comorbities. Multiple approaches have been described, including the use of laparoscopy. The purpose of this study was to determine if laparoscopic approaches for repair of rectal prolapse are associated with less short-term morbidity than open approaches. Methods:The ACS NSQIP database was queried for patients who underwent laparoscopic or open rectopexy (R) or sigmoid resection and rectopexy (SR+R) between 2005 and 2008. Comorbidities analyzed included diabetes, COPD, hypertension, cardiac (history of congestive heart failure, myocardial infarction, previous percutaneous cardiac intervention or surgery), and neurologic (history of transient ischemic attack or cerebrovascular accident). Postoperative complications analyzed included surgical site infections (SSI), pneumonia, reintubation, pulmonary embolus, stroke, myocardial infarction, and sepsis. Chi-square or t-test/ANOVAs were used to assess significance for categorical and continuous variables, respectively. Logistic regression analysis was used to determine risk factors for morbidity after rectal prolapse repair. Results:685 patients underwent surgical treatment of rectal prolapse. Most patients underwent open SR+R (247 open SR+R, 193 open R, 161 laparoscopic SR+R, 84 laparoscopic R). Patients undergoing all procedures had similar comorbidity profiles, but the patients who had a laparoscopic R were significantly older patients (mean age 61.4 years) than the other three groups (p=0.04). Operating time ranged from 128 minutes (open R) to 185 minutes (laparoscopic SR +R; p<0.001). Overall, open SR+R and open R were associated with significantly more morbidity than laparoscopic SR+R and R (OR 0.44, 95% CI 0.23-0.84, p=0.01). Comparing all four procedure types, there was a trend to decreased overall morbidity with laparoscopic R, but it did not achieve statistical significance (OR 0.31, 95% CI 0.07-1.40, p=0.13). Length of stay and SSI rates were significantly lower with laparoscopic R as compared to the other three procedure types (see Table 1). Conclusions:Patients who undergo laparoscopic rectopexy have a shorter length of stay and lower SSI rate as compared to patients who undergo other abdominal procedures for repair of rectal prolapse. Further study is necessary to determine the long-term outcomes from laparoscopic rectopexy, but in high-risk patients, the laparoscopic approach should be considered to decrease perioperative risk.
Table 1.

Procedure type	N	Length of stay, days	Surgical site infections, n (%)	Overall complication rate, n (%)
Open rectopexy (R)	193	5.3	16 (8.3)	14 (7.3)
Open sigmoid resection and rectopexy (SR+R)	247	7.9	35 (14.2)	34 (13.7)
Laparoscopic rectopexy (R)	84	3.2	0 (0.0)	2 (2.4)
Laparoscopic sigmoid resection and rectopexy (SR+R)	161	5.4	11 (6.8)	11 (6.8)
		*p<0.001	*p<0.001	*p<0.001