Abstract
Background
Laparoscopic repair (LR) of rectal prolapse is potentially associated with earlier recovery and lower perioperative morbidity, as compared with open transabdominal repair (OR). Data on the long-term recurrence rate and functional outcome are limited.
Methods
Perioperative data on rectal prolapse in relation to all LRs performed between December 1991 and April 2004 were prospectively collected. The LR patients were matched by age, gender, and procedure type with OR patients who underwent surgery during the same period. Patients with previous complex abdominal surgery or a body mass index exceeding 40 were excluded from the study. Data on recurrence rate, bowel habits, continence, and satisfaction scores were collected using a telephone survey.
Results
A total of 111 patients (age, 56.8 ± 18.1 years; female, 87%) underwent attempted LR. An operative complication deferred repair in two cases. Among the 111 patients, 42 had posterior mesh fixation, and 67 had sutured rectopexy (32 patients with sigmoid colectomy for constipation). Eight patients (7.2%) had conversion to laparotomy. Matching was established for 86 patients. The LR patients had a shorter hospital stay (mean, 3.9 vs 6.0 days; p < 0.0001). The 30-day reoperation and readmission rates were similar for the two groups. The rates for recurrence requiring surgery were 9.3% for LR and 4.7% for OR (p = 0.39) during a mean follow-up period of 59 months. An additional seven patients in each group reported possible recurrence by telephone. Postoperatively, 35% of the LR patients and 53% of the OR patients experienced constipation (p = 0.09). Constipation was improved in 74% of the LR patients and 54% of the OR patients, and worsened, respectively, in 3% and 17% (p = 0.037). The postoperative incontinence rates were 30% for LR and 33% for OR (p = 0.83). Continence was improved in 48% of the LR patients and 35% of the OR patients, and worsened, respectively, in 9% and 18% (p = 0.22). The mean satisfaction rates for surgery (on a scale of 0 to10) were 7.3 for the LR patients and 8.1 for the OR patients (p = 0.17).
Conclusions
The hospital stay is shorter for LR than for OR. Both functional results and recurrent full-thickness rectal prolapse were similar for LR and OR during a mean follow-up period of 5 years.
Similar content being viewed by others
References
Delaney CP, Senagore AJ (2005) Rectal prolapse. In: Fazio VW, Church JM, Delaney CP (eds) Current therapy in colon and rectal surgery. 2nd ed.. Elsevier, Mosby Inc., Philadelphia, PA pp 131–134
Madden MV, Kamm MA, Nicholls RJ, Santhanam AN, Cabot R, Speakman CT (1995) Abdominal rectopexy for complete rectal prolapse: prospective study evaluating changes in symptoms and anorectal function. Dis Colon Rectum 35: 301–307
Keighley MR, Fielding JW, Alexander-Williams J (1983) Results of Marlex mesh abdominal rectopexy for rectal prolapse in 100 consecutive patients. Br J Surg 70: 229–232
Madoff RD, Williams JG, Wong WD, Rothenberger DA, Goldberg SM (1992) Long-term functional results of colon resection and rectopexy for overt rectal prolapse. Am J Gastroenterol 87: 101–104
Metcalf AM, Loening-Baucke V (1988) Anorectal function and defecation dynamics in patients with rectal prolapse. Am J Surg 155: 206–210
Aitola PT, Hiltunen K-M, Matikainen MJ (1999) Functional results of operative treatment of rectal prolapse over an 11-year period: emphasis on transabdominal approach. Dis Colon Rectum 42: 655–660
Deen KI, Grant E, Billingham C, Keighley MR (1994) Abdominal resection rectopexy with pelvic floor repair versus perineal rectosigmoidectomy and pelvic floor repair for full-thickness rectal prolapse. Br J Surg 81: 302–304
Jacobs LK, Lin YJ, Orkin BA (1997) The best operation for rectal prolapse. Surg Clin North Am 77: 49–70
Kim DS, Tsang CB, Wong WD, Lowry AC, Goldberg SM, Madoff RD (1999) Complete rectal prolapse: evolution of management and results. Dis Colon Rectum 42: 460–469
Loygue J, Nordlinger B, Cunci O, Malafosse M, Huguet C, Parc R (1984) Rectopexy to the promontory for treatment of rectal prolapse: report of 257 cases. Dis Colon Rectum 27: 356–359
Madoff RD, Mellgren A (1999) One hundred years of rectal prolapse surgery. Dis Colon Rectum 42: 441–450
Berman IR (1992) Sutureless laparoscopic rectopexy for procidentia: technique and implications. Dis Colon Rectum 35: 689–693
Baker R, Senagore AJ, Luchtefeld MA (1995) Laparoscopic assisted vs open resection: rectopexy offers excellent results. Dis Colon Rectum 38: 199–201
Cuschieri A, Shimi SM, Vander Velpen G, Banting S, Wood RA (1994) Laparoscopic prosthesis fixation rectopexy for complete rectal prolapse. Br J Surg 81: 138–139
Darzi A, Henry MM, Guillou PJ, Shorvon P, Monson JR (1995) Stapled laparoscopic rectopexy for rectal prolapse. Surg Endosc 9: 301–303
Heah SM, Hartley JE, Hurley J, Duthie GS, Monson JR (2000) Laparoscopic suture rectopexy without resection is effective treatment for full-thickness rectal prolapse. Dis Colon Rectum 43: 638–643
Kellokumpu IH, Vironen J, Scheinin T (2000) Laparoscopic repair of rectal prolapse: a prospective study evaluating surgical outcome and changes in symptoms and bowel function. Surg Endosc 14: 634–640
Kessler H, Jerby BL, Milsom JW (1999) Successful treatment of rectal prolapse by laparoscopic suture rectopexy. Surg Endosc 13: 858–861
Senagore AJ (2003) Management of rectal prolapse: the role of laparoscopic approaches. Semin Laparosc Surg 10: 197–202
Stevenson AR, Stitz RW, Lumley JW (1998) Laparoscopic assisted resection rectopexy for rectal prolapse: early and medium follow-up. Dis Colon Rectum 41: 46–54
Boccasanta P, Venturi M, Reitano MC, Salamina G, Rosati R, Montorsi M, Fichera G, Strinna M, Peracchia A (1999) Laparotomic vs laparoscopic rectopexy in complete rectal prolapse. Dig Surg 16: 415–419
Kairaluoma MV, Viljakka MT, Kellokumpu IH (2003) Open vs laparoscopic surgery for rectal prolapse: a case–controlled study assessing short-term outcome. Dis Colon Rectum 46: 353–360
Madbouly KM, Senagore AJ, Delaney CP, Duepree HJ, Brady KM, Fazio VW (2003) Clinically based management of rectal prolapse. Surg Endosc 17: 99–103
Salkeld G, Bagia M, Solomon M (2004) Economic impact of laparoscopic versus open abdominal rectopexy. Br J Surg 91: 1188–1191
Solomon MJ, Young CJ, Eyers AA, Roberts RA (2002) Randomized clinical trial of laparoscopic versus open abdominal rectopexy for rectal prolapse. Br J Surg 89: 35–39
Casillas S, Delaney CP, Senagore AJ, Brady K, Fazio VW (2004) Does conversion of a laparoscopic colectomy adversely affect patient outcome? Dis Colon Rectum 47: 1680–1685
Schwandner O, Schiedeck TH, Bruch H (1999) The role of conversion in laparoscopic colorectal surgery: do predictive factors exist? Surg Endosc 13: 151–156
Slim K, Pezet D, Riff Y, Clark E, Chipponi J (1995) High morbidity rate after converted laparoscopic colorectal surgery. Br J Surg 82: 1406–1408
Delaney CP, Kiran RP, Brady K, Fazio VW (2003) Case-matched comparison of clinical and financial outcome after laparoscopic or open colectomy. Ann Surg 238: 67–72
Benoist S, Taffinder N, Gould S, Chang A, Darzi A (2001) Functional results two years after laparoscopic rectopexy. Am J Surg 182: 168–173
Bruch HP, Herold A, Schiedeck T, Schwander O (1999) Laparoscopic surgery for rectal prolapse and outlet obstruction. Dis Colon Rectum 42: 1189–1195
Hool GR, Hull TL, Fazio VW (1997) Surgical treatment of recurrent complete rectal prolapse: a thirty-year experience. Dis Colon Rectum 40: 270–272
Novell JR, Osborne MJ, Winslet MC, Lewis AA (1994) Prospective randomized trial of Ivalon sponge versus sutured rectopexy for full thickness prolapse. Br J Surg 81: 904–906
Senagore AJ, Delaney CP, Madboulay K, Brady KM, Fazio VW (2003) Laparoscopic colectomy in obese and nonobese patients. J Gastrointest Surg 7: 558–561
Senagore AJ, Madbouly KM, Fazio VW, Duepree HJ, Brady KM, Delaney CP (2003) Advantages of laparoscopic colectomy in older patients. Arch Surg 138: 252–256
Blatchford GJ, Perry RE, Thorson AG, Christensen MA (1989) Rectopexy without resection for rectal prolapse. Am J Surg 158: 574–576
Graf W, Karlbom U, Pahlman L, Nilsson S, Ejerblad S (1996) Functional results after abdominal suture rectopexy for rectal prolapse or intussusception. Eur J Surg 162: 905–911
Tjandra JJ, Fazio VW, Church JM, Milsom JW, Oakley JR, Lavery IC (1993) Ripstein procedure is an effective treatment for rectal prolapse without constipation. Dis Colon Rectum 36: 501–507
Zittel TT, Manncke K, Haug S, Schafer JF, Kreis ME, Becker HD, Jehle EC (2000) Functional results after laparoscopic rectopexy for rectal prolapse. J Gastrointest Surg 4: 632–641
Dolk A, Broden G, Holmstrom B, Johansson C, Nilsson BY (1990) Slow transit of the colon associated with severe constipation after the Ripstein operation: a clinical and physiologic study. Dis Colon Rectum 33: 786–790
Scaglia M, Fasth S, Hallgren T, Nordgren S, Oresland T, Hulten L (1994) Abdominal rectopexy for rectal prolapse: influence of surgical technique on functional outcome. Dis Colon Rectum 37: 805–813
Speakman CT, Madden MV, Nicholls RJ, Kamm MA (1991) Lateral ligament division during rectopexy causes constipation but prevents recurrence: results of a prospective randomized study. Br J Surg 78: 1431–1433
McKee R, Lauder JC, Poon FW, Aitchison MA, Finlay IG (1992) A prospective randomized study of abdominal rectopexy with and without sigmoidectomy in rectal prolapse. Surg Gynecol Obstet 174: 145–148
Sayfan J, Pinho M, Alexander-Williams J, Keighley MR (1990) Sutured posterior abdominal rectopexy with sigmoidectomy compared with Marlex rectopexy for rectal prolapse. Br J Surg 77: 143–145
Schultz I, Mellgren A, Dolk A, Johansson C, Holmstrom B (2000) Long-term results and functional outcome after Ripstein rectopexy. Dis Colon Rectum 43: 35–43
Parks AG, Swash M, Urich H (1977) Sphincter denervation in anorectal incontinence and rectal prolapse. Gut 18: 656–665
Spencer RJ (1984) Manometric studies in rectal prolapse. Dis Colon Rectum 27: 523–525
Duthie GS, Bartolo DC (1992) Abdominal rectopexy for rectal prolapse: a comparison of techniques. Br J Surg 79: 107–113
Xynos E, Chrysos E, Tsiaoussis J, Epanomeritakis E, Vassilakis JS (1999) Resection rectopexy for rectal prolapse: the laparoscopic approach. Surg Endosc 13: 862–864
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kariv, Y., Delaney, C.P., Casillas, S. et al. Long-term outcome after laparoscopic and open surgery for rectal prolapse. Surg Endosc 20, 35–42 (2006). https://doi.org/10.1007/s00464-005-3012-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-005-3012-2