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Laparoscopic Ventral Bio-mesh Rectopexy for Internal and External Rectal Prolapse.
Pierpaolo Sileri*1, Mostafa Shalaby1,2, Luana Franceschilli1, Giulia Missori1, Silvia Quaresima1, Ilaria Capuano1
1Surgery, University of Rome Tor Vergata, Rome, Italy; 2Surgery, Mansoura University, Mansoura, Egypt
Background: Laparoscopic Ventral Mesh Rectopexy (LVR) corrects internal and external rectal prolaspe with excellent functional outcome in terms of constipation and incontinence resolution. LVR is associated to a unique safety even in older and fragile patients.
These results are usually obtained using synthetic meshes, while very few reports on biologic mesh exist for LVR. This lack of data does not allow to establish an indisputable superiority of any biological mesh in terms of surgical complications, as well as short and longer term functional outcomes.
In this study we report our experience with this abdominal, minimally invasive and nerve sparing technique, using porcine dermal collagen mesh.
Patients and Methods: Prospectively collected data about laparoscopic ventral mesh rectopexy (LVR) for internal and external 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. The grade of prolapse was evaluated by Oxford Prolapse Grading System
Surgical complications and functional results of this technique in terms of constipation (expressed as Wexner Constipation Score) and Faecal Incontinence (expressed as Fecal Incontinence Severity Index) at 3, 6, 12 and 12 months were analysed using Mann-Whitney U-test for unpaired data and Wilcoxon signed rank test for paired data (two-sided p-test).
Results: Between April 2009 and October 2015, 179 consecutive patients underwent LVR for internal rectal prolapse. Four patients were lost during the follow-up and excluded.
Mean symptoms duration before surgery was 10+/-7 years. Mean operative time was 70 minutes. Conversion rate to open technique was 1%. There was no postoperative mortality. Overall patients experienced complications were 28 (16%), including the rectal perforation (1 patient), small bowel obstruction (2), intrabdominal bleeding (2), urinary tract infection (9), subcutaneous emphysemas (5), wound hematomas (6), sacral long lasting pain (1), and incisional hernia (2). Median postoperative length of stay was 2 days.
At the end of the follow-up FISI score significantly improved to 3+/-2 from preoperative 7+/-3 (p 0.04), and incontinence improved in 83% of the patients, cured in 77%.
Similarly, WCS score significantly improved to 8+/-5 from preoperative 18+/-5 (p 0.03), and constipation improved in 87% of the patients, cured in 80%.
No patients experienced incontinence, constipation or sexual activity worsening. Seventeen patients (9.4%) experienced prolapse persistence/recurrence.
Conclusions: laparoscopic ventral mesh rectopexy using biological mesh for internal rectal prolapse is safe and effective in improving symptoms of obstructed defecation and faecal incontinence.
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