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Laparoscopic Ventral Mesh Rectopexy Compared to Stapled Trans-Anal Rectal Resection (STARR) to Treat Internal Rectal Prolapse: a Matched Cohorts Study
Pierpaolo Sileri*, Luana Franceschilli, Federica Giorgi, Ilaria Capuano, Achille Gaspari
surgery, University of Rome Tor Vergata, Rome, Italy
Background: Laparoscopic Ventral Mesh Rectopexy (LVR) corrects both, internal and external rectal prolapse, improving obstructed defaecation symptoms (ODS) and faecal incontinence. Similarly, Stapled Trans-Anal Rectal Resection (STARR) allows resolution of ODS. However data from retrospective series or prospective trials comparing the two procedures for internal rectal prolapse (IRP, defined as recto-rectal or recto-anal intussusception) are absent. In this matched cohorts study we compared outcomes in terms of surgical complications and functional results of LVR and STARR in order to better understand the ideal surgical approach for IRP.
Patients and Methods: All patients underwent preoperative evaluation with defaecating proctography or pelvic dynamic MRI. Only patients with recto-rectal or recto-anal intussusception, rectocoele with or without enterocoele or sigmoidocoele were considered from our prospectively kept database. Patients with concomitant middle and anterior pelvic compartment prolapses, were excluded. Two groups of patients were considered according to the surgical technique (LVR or STARR) and matched for demographics, symptoms and characteristics of the prolapse. Only patients with a minimum of 1 year follow-up were considerd. End-points were surgical complications and functional results expressed as Wexner Constipation Score (WCS) and Faecal Incontinence Severity Index (FISI).
Results: Twenty-seven patients who underwent LVR were compared to 27 patients who underwent STARR.
After LVR, overall complications rate was 15% similar to STARR (11%), all minor.
After LVR, WCS significantly improved to 5+/-3 from preoperative 15+/-5 (p 0.03). Constipation improved in 89% and was cured in 81%. Similarly, after STARR, WCS score significantly improved to 6+/-5 from preoperative 16+/-11(p 0.03). Recurrence rate was 22%. Constipation improved in 85% and was cured in 78%. No significative differences were observed between the two groups.
Considering incontinence, after LVR the FISI score significantly improved to 2+/-2 from preoperative 7+/-3 (p 0.03). Incontinence improved in 90% and was completely cured in 90%.
After STARR, the FISI score improved to 4+/-2 from preoperative 8+/-5(p 0.06). Incontinence improved in 54% and was completely cured in 45%. These percentages were significantly lower compared to those observed after LVR.
Conclusions: LVR and STARR seems to be equally valid to treat constipation associated to IRP, but LVR has greater chances to cure incontinence.
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