Laparoscopic ventral rectopexy for external rectal prolapse improves constipation and avoids de novo constipation

Area of Science:

• Colorectal surgery
• Minimally invasive surgery
• Pelvic floor disorders

Background:

• Rectal prolapse management often involves rectopexy, but posterior approaches can lead to significant postoperative constipation.
• Ventral rectopexy is a nerve-sparing technique hypothesized to mitigate this common complication.
• Evaluating functional outcomes of laparoscopic ventral rectopexy is crucial for optimizing patient care.

Purpose of the Study:

• To assess the functional outcomes of laparoscopic ventral rectopexy in patients with rectal prolapse.
• To evaluate the impact on constipation and fecal incontinence.
• To compare functional results with historical data from posterior rectopexy.

Main Methods:

• Prospective assessment of consecutive patients undergoing laparoscopic ventral rectopexy.
• Utilized Wexner Constipation and Faecal Incontinence Severity Index scores for pre- and postoperative evaluation.
• Follow-up included assessments at 3 months and late (>12 months).

Main Results:

• Laparoscopic ventral rectopexy demonstrated a low recurrence rate (<5%) and low morbidity.
• Significant improvement in constipation (72% improved) and continence (83% improved) was observed at 3 months.
• These functional improvements were sustained at late follow-up (>12 months), with no significant de novo constipation.

Conclusions:

• Laparoscopic ventral rectopexy is a safe and effective treatment for rectal prolapse with low recurrence rates.
• The procedure significantly improves preoperative constipation and avoids de novo constipation, outperforming historical posterior rectopexy results.
• The minimally invasive approach offers low morbidity and short hospital stays, even in elderly patients.