Clinical Outcome after Resection Rectopexy in patients with Constipation and Rectal Prolapse

Document Type : Research/Original Article

Authors

1 Clinic for General and Visceral Surgery, Kepler University Clinic

2 Department of Applied Systems Research and Statistics, Johannes Kepler University

Abstract

Introduction: Laparoscopic resection rectopexy (LRR) is an established procedure for the treatment of rectal prolapse. This study evaluated constipation and gastrointestinal quality of life in patients before and after LRR for rectal prolapse.
Methods: 30 patients (24 females, 6 males) underwent laparoscopic anterior (n = 14), posterior (n = 8) and suture resection rectopexy (n = 8) for rectal prolapse during 2010 – 2020. 25 were retrospectively evaluated for constipation and gastrointestinal quality of life using validated Cleveland Clinic Constipation Score (CCCS) and Gastrointestinal Quality of Life Index (GIQLI).
Results: Constipation score was significantly reduced from median 16.0 ± 6.4 to 6.0 ± 4.7 after 68.0 ± 42.8 months (p < 0.001). Constipation was improved in 20 patients (80.0%), unaltered in 2 patients and worse in 3 patients. Prior abdominal surgeries were associated with less improvement for constipation (p < 0,05). Significant improvement in GIQLI score was observed, with median total GIQLI score increasing from 95.0 ± 14.8 to 124.0 ± 18.2 (p < 0.001). Quality of life improved in 21 patients (84.0%). Positive changes were also observed in GIQLI subgroups of gastrointestinal symptoms, emotions, physical status, social dysfunction and effects of medical treatment (p < 0.001). There was no difference in outcome between the three procedures.
Conclusion: Laparoscopic resection rectopexy for rectal prolapse is safe, feasible, and very effective regarding both perioperative results and long-term functional outcome. Our results suggest that LRR significantly improves constipation in patients with outlet obstruction and clearly contributes to a higher quality of life.

Keywords

References

1.         Jacobs LK, Lin YJ, Orkin BA. The best operation for rectal prolapse. Surg Clin North Am.  1997; 77(1):49–70.
2.         Madiba TE, Baig MK, Wexner SD. Surgical management of rectal prolapse. Arch Surg.  2005; 140(1):63–73.
3.         Vergeldt TFM, Weemhoff M, IntHout J, Kluivers KB. Risk factors for pelvic organ prolapse and its recurrence: a systematic review. Int Urogynecol J. 2015;26(11):1559–73.
4.         Suares NC, Ford AC. Prevalence of, and risk factors for, chronic idiopathic constipation in the community: systematic review and meta-analysis. Am J Gastroenterol. 2011;106(9):1582–91; quiz 1581, 1592.
5.         Sonnenberg A, Koch TR. Epidemiology of constipation in the United States. Dis Colon Rectum. 1989;32(1):1–8.
6.         Shin EJ. Surgical treatment of rectal prolapse. Journal of the Korean Society of Coloproctology. 2011 Feb;27(1):5-12.
7.         Hany S, Abo-Elkheir M, Ahmed S, El-Awady S, Farid M, Ghazy H. Laparoscopic resection rectopexy versus laparoscopic mesh rectopexy for rectoanal intussusception. Egypt J Surg. 2015; 34(1):48.
8.         Rickert A, Kienle P. Laparoscopic surgery for rectal prolapse and pelvic floor disorders. World J Gastrointest Endosc. 2015;7(12):1045–54.
9.         Tou S, Brown SR, Malik AI, Nelson RL. Surgery for complete rectal prolapse in adults. Cochrane Database of Systematic Reviews [Internet]. 2008; (4):CD001758
10.       D’Hoore A, Cadoni R, Penninckx F. Long-term outcome of laparoscopic ventral rectopexy for total rectal prolapse. BJS (British Journal of Surgery). 2004;91(11):1500–5.
11.       Bove A, Bellini M, Battaglia E, Bocchini R, Gambaccini D, Bove V, u. a. Consensus statement AIGO/SICCR diagnosis and treatment of chronic constipation and obstructed defecation (Part II: Treatment). World J Gastroenterol. 2012;18(36):4994–5013.
12.       Formijne Jonkers HA, Maya A, Draaisma WA, Bemelman WA, Broeders IA, Consten ECJ, u. a. Laparoscopic resection rectopexy versus laparoscopic ventral rectopexy for complete rectal prolapse. Tech Coloproctol. 2014;18(7):641–6.
13.       Laubert T, Kleemann M, Schorcht A, Czymek R, Jungbluth T, Bader FG, u. a. Laparoscopic resection rectopexy for rectal prolapse: a single-center study during 16 years. Surg Endosc. 2010; 24(10):2401–6.
14.       Mollen RM, Kuijpers JH, van Hoek F. Effects of rectal mobilization and lateral ligaments division on colonic and anorectal function. Dis Colon Rectum. 2000;43(9):1283–7.
15.       Xynos E, Chrysos E, Tsiaoussis J, Epanomeritakis E, Vassilakis JS. Resection rectopexy for rectal prolapse. The laparoscopic approach. Surgical endoscopy. 1999;13:862–4.
16.       Ashari LHS, Lumley JW, Stevenson ARL, Stitz RW. Laparoscopically-assisted resection rectopexy for rectal prolapse: ten years’ experience. Dis Colon Rectum. 2005;48(5):982–7.
17.       Senapati A, Gray RG, Middleton LJ, Harding J, Hills RK, Armitage NCM, u. a. PROSPER: a randomised comparison of surgical treatments for rectal prolapse. Colorectal Dis. 2013;15(7):858–68.
18.       Stevenson ARL, Stitz RW, Lumley JW. Laparoscopic-assisted resection-rectopexy for rectal prolapse: Early and medium follow-up. Diseases of the Colon & Rectum. 1998;41(1):46–54.
19.       Kariv Y, Delaney CP, Casillas S, Hammel J, Nocero J, Bast J, u. a. Long-term outcome after laparoscopic and open surgery for rectal prolapse: a case-control study. Surg Endosc. 2006;20(1):35–42.
 
Iranian Journal of Colorectal Research
Volume 9, Issue 1
March 2021
Pages 12-17

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