Laparoscopic Ventral Rectopexy for Rectal Prolapse Using Biological Mesh
Pierpaolo Sileri1, Luana Franceschilli*1, Sara Lazzaro1, Giulio P. Angelucci1, Lodovico Patrizi3, Valeria Fiaschetti2, Emilio Piccione3, Achille Gaspari1
1Surgery, University of Rome Tor Vergata, Rome, Italy; 2Radiology, University of Rome Tor Vergata, Rome, Italy; 3Gynaecology, University of Rome Tor Vergata, Rome, Italy
Background: Laparoscopic Ventral Mesh Rectopexy (LVR) is a novel procedure to correct internal and external rectal prolapse. Several authors have shown that this approach is safe and improves obstructive defecation symptoms and faecal incontinence, without inducing new-onset constipation, possible after posterior rectopexy. Over the last decade, as for other procedures, the use of biological mesh has been extended to correct pelvic floor disorders. However literature data is scant. In this study we present our experience with this procedure using biological mesh.Methods: Prospectively collected data on LVR for internal rectal prolapse were analysed. All patients underwent preoperative evaluation with defaecating proctography and/or pelvic dynamic MRI, full colonoscopy, anal physiology studies, and endo-anal ultrasound. A four trocars technique has been used. Briefly, a very superficial peritoneal window was made from the right sacral promontory, over the right outer border of the mesorectum down towards the right and left side of the deep Douglas pouch. The longitudinal incision was terminated as low as possible close to the pelvic floor creating behind the vagina a 4-5 cm pouch. A biological mesh was then sutured anteriorly on the rectum with two parallel rows of interrupted non-absorbable stitches and secured proximally on the sacral promontory. End-points were to evaluate surgical complications and functional results of this technique such as changes in bowel function (Wexner Constipation Score and Faecal Incontinence Severity Index) at 3 and 6 months. Analysis was performed using Mann-Whitney U-test for unpaired data and Wilcoxon signed rank test for paired data (two-sided p-test).Results: Twenty-five consecutive patients underwent LVR (median age 61 range 46-78 years, median follow up was 4 months). Nineteen patients (76%) had a constipation score >5, while nine (36%) a FISI score >10. Three patients (12%) had mixed OD and FI. One patient required conversion to open (3%). Median length of stay was 2 days. We did not observe mortality or major morbidity. Two patients experienced UTI (8%). Preoperative constipation (median Wexner score 14) and faecal incontinence (median FISI score 11) improved significantly at 3 months (Wexner 3, FISI 4, both p<0.001). One patient (3%) required Stapled Transanal Rectal Resection (STARR) for persisting symptoms 6 months after surgery. No patients had function worsening. No patients complained of sexual dysfunction.Conclusions: Laparoscopic ventral rectopexy using biological mesh for internal rectal prolapse is safe and effective in ameliorating symptoms of obstructed defecation and faecal incontinence.
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