[Laparoscopic treatment of rectal prolapse]

Rectal prolapse is an uncommon disease mainly seen in patients of advanced age. It is treated surgically, although there is still significant controversy as regards the most appropriate technique. In the last few years the laparoscopic route has been shown to be feasible and has the advantage of being a minimally invasive technique.

To present the preliminary results of a series of patients with rectal prolapse, the majority of whom were treated by performing a laparoscopic posterior rectopexy.

Between February 1998 and February 2008, 17 patients diagnosed with total rectal prolapse were operated on. In 15 cases, a Wells type posterior rectopexy was performed and in the other two a sigmoidectomy was done. The pre-surgical characteristics, as well as the immediate post-surgical results and the long-term follow up results were analysed.

The mean age of the series was 63 (21-87) years, with a mean operation time of 186 (105-240) min and a conversion index of 6.6%. There was no post-surgical morbidity and mortality and the mean hospital stay was 5.2 (3-8) days. The mean follow-up was 39 (6-96) months with no relapses seen. One patient had an intralumen migration of the mesh which was expulsed via the rectum, two years after the surgery. One patient died during follow-up due to his underlying severe cardio-respiratory disease. The prolapse re-occurred in one patient after a sigmoidectomy. Eight patients (53%) previously had constipation and in six cases (40%), incontinence. In the post-surgical reviews, constipation persisted in three patients (20%) and a it was seen de novo in one case (6.6%). The incontinence was resolved in four cases (26%) and persisting in two patients (13%).

Laparoscopic rectopexy is a good technical option with a low morbidity-mortality and a reduced hospital stay, as well as good results in the long-term.