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Related Experiment Videos

Clinically based management of rectal prolapse.

K M Madbouly1, A J Senagore, C P Delaney

  • 1Department of Colorectal Surgery and the Minimally Invasive Surgery Center, Cleveland Clinic Foundation, 9500 Euclid Ave, Desk A-111, Cleveland, OH 44195, USA.

Surgical Endoscopy
|October 3, 2002
PubMed
Summary

This study compared laparoscopic resection with rectopexy (LRR) and laparoscopic Wells procedure (LWP) for rectal prolapse. Both methods showed good outcomes and low recurrence, with symptom-based selection proving effective.

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Area of Science:

  • Colorectal Surgery
  • Minimally Invasive Surgery
  • Gastroenterology

Background:

  • Laparoscopic rectal prolapse repair offers potential for lower recurrence rates and minimally invasive benefits.
  • No direct comparisons existed between laparoscopic Wells procedure (LWP) and laparoscopic resection with rectopexy (LRR).
  • This study provides the first direct comparison of LRR and LWP outcomes based on symptom selection.

Purpose of the Study:

  • To directly compare the outcomes of laparoscopic resection with rectopexy (LRR) and laparoscopic Wells procedure (LWP) for complete rectal prolapse.
  • To evaluate the efficacy of symptom-based selection for choosing between LRR and LWP.
  • To assess recurrence rates, functional outcomes, and complications associated with each laparoscopic technique.

Main Methods:

Related Experiment Videos

  • A consecutive series of patients with complete rectal prolapse were evaluated based on clinical history of constipation, diarrhea, or incontinence.
  • Patients with constipation or normal bowel habits underwent LRR; those with diarrhea or incontinence underwent LWP.
  • Data collected included demographics, operative time, length of stay (LOS), blood loss, complications, and postoperative bowel function and continence scores.

Main Results:

  • Of 24 patients, 11 had LRR and 13 had LWP. LRR patients were significantly younger and had longer operative times and LOS.
  • No recurrences were observed during a mean 18.1-month follow-up.
  • LRR successfully corrected constipation in 10/11 patients; LWP improved incontinence in 4/5 patients. LRR had higher morbidity (3 complications) compared to LWP.

Conclusions:

  • Clinical assessment of preoperative bowel function and continence is sufficient for selecting the appropriate laparoscopic rectal prolapse repair technique.
  • Both LRR and LWP offer good functional outcomes, short LOS, and low recurrence rates for rectal prolapse.
  • While LRR may have higher initial morbidity, both procedures are effective minimally invasive options.