Abstracts
1999 Digestive Disease Week

# 2097 FUNCTIONAL LONG-TERM RESULTS AFTER LAPAROSCOPIC RECTOPEXY OPERATION FOR RECTAL PROLAPS OR INTUSSUCEPTION
Tilman Zittel, Univ Hosp Tuebingen, Tubingen Germany; K Manncke, S Haug, K Winter, M E Kreis, H D Becker, E C Jehle, Univ Hosp, Tubingen Germany

Introduction. Laparoscopic rectopexy is the treatment of choice for rectal prolaps or intussecption. Since laparoscopic technique has been introduced only recently, reports on the long-term functional outcome are still scarce. We investigated the outcome of our patients treated by laparoscopic rectopexy at least one year after surgery. Patients and Methods. Between 1/1/1993 and 8/30/1997, a total of 35 patients were treated by laparoscopic posterior rectopexy using a prolene mesh (Wells procedure) for rectal prolaps or intussusception. No sigmoidectomy was done with rectopexy. 20 patients could be reached for a follow-up investigation at least one year after surgery (range 12-42 months). Patients were investigated by standardized interview, clinical examination, anoscopy and rigid sigmoidoscopy, rectal manometry and defecography. Results. Soiling, change of underwear and social or occupational handicaps were significantly reduced postoperatively. Preoperatively, 13 patients reported on anal incontinence at least once a week compared to 7 patients postoperatively. Incomplete evacuation was reported by 10 patients preoperatively and by 13 patients postoperatively. Postoperatively, a minor intussusception was detectable in 4 patients by anoscopy and defecography. One patient had recurrence of rectal prolaps 3 1/2 years postoperatively. A significant increase of squeeze and resting pressure could be measured postoperatively (142±19 vs 105±17 mmHg, p<0.05; 95±12 vs 78±10 mmHg, p<0.05). The defecography showed a significant increase og the recto-anal angle during defecation postoperatively (152±4o vs 164±3o, p<0.05), while the resting recto-anal angle was unchanged (136±4o vs 134±4o, n.s.). By defecography, a rectocele could be shown in 16/20 patients preoperatively. Postoperatively, the rectocele was unchanged in 5 patients, reduced in size in 8 patients, and increased in size in 3 patients. Sexual function was impaired in one patient postoperatively, being the only major complication observed. On a scale of 1 (totally unsatisfied) to 10 (completely satisfied), 12 patients gave 8-10 points, 4 patients 4-6 points, and 4 patients 1-3 points. 15 patients stated that they would choose surgical treatment again, 3 patients perhaps, and 2 patients definitively not. Conclusions. In the majority of patients, rectal prolapse or intussusception can be treated successfully by laparoscopic rectopexy. Symptoms of incontinence were improved in the majority of patients, whereas evacuation disturbances are not improved. Severe, but rather rare problems were recurrence of prolapse or impaired sexual function. When offering patients surgical treatment of rectal prolapse or intussusception, these problems must be kept in mind and discussed with the patient.

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