Background: There is no clear treatment of choice for the problem of complete rectal
prolapse. The treatment of CRP in adults is essentially surgical. Surgical management
is aimed at restoring physiology by correcting the prolapse and improving continence
and constipation with acceptable mortality and recurrence rates
Objectives: To determine the safety and outcome of laparoscopic ventral mesh
rectopexy (LVMR) for the management of CRP patients.
Patients & Methods: The study included 33 CRP patients; 20 females and 13 males.
Females were significantly obese than males; however, males were significantly older.
Four females had associated vaginal vault prolapse. All patients underwent LVMR.
Surgical outcome included intraoperative (IO), postoperative (PO) and follow-up data.
Functional outcome was assessed at 6-m and 12-m PO and compared versus
preoperative evaluation for severity of fecal incontinence (FI) using Vaizey score,
frequency and severity of constipation using Cleveland Clinic Constipation (CCC)
score and impact of FI on patient's quality of life (QOL) using the Fecal incontinence
quality of life scale (FIQL) score (11).
Results: All patients passed smooth uneventful operative and immediate postoperative
course. No patient required conversion to laparotomy. Mean operative time was
151.9±31.6 (range: 120-240 min) and mean amount of IO blood loss was 75.2±16
(range: 50-130 ml). Laparoscopic surgery provided its usual advantages concerning low
PO pain score, and early ambulation, oral intake, and hospital discharge. Only three
patients (9.1%) developed immediate PO complications. All patients showed
significant functional improvement manifested as a significant decrease of Vaizey FI
and CCC scores with a significant increase of FIOL score at 6-m PO and these scorings
were progressively improved till 12-m PO. Throughout 12 months PO follow-up; two
female patients developed recurrent rectal prolapse for a frequency of 6.1%.
Conclusion: LVMR is a safe procedure for management of CRP within reasonable
operative time and with minimal immediate PO morbidities. LVMR provided
significant improvement of CRP-associated FI and constipation and its impact on
patients QOL. LVMR is associated with low frequency of PO recurrence throughout
12-m follow-up. |
