Laparoscopic ventral rectopexy for internal rectal prolapse: short-term functional results

Area of Science:

• Colorectal surgery
• Gastroenterology
• Pelvic floor disorders

Background:

• Posterior rectopexy previously led to poor outcomes for internal rectal prolapse due to rectal autonomic denervation.
• Internal rectal prolapse management shifted towards non-surgical options like biofeedback.
• There was a need for effective surgical interventions preserving autonomic nerve function.

Purpose of the Study:

• To evaluate the short-term functional outcomes of autonomic nerve-sparing laparoscopic ventral rectopexy (LVR).
• To assess the impact of LVR on symptoms of obstructed defecation and fecal incontinence.
• To establish proof of concept for nerve-sparing surgery in internal rectal prolapse.

Main Methods:

• Prospective data collection from 75 patients undergoing LVR for internal rectal prolapse.
• Assessment of bowel function using Wexner Constipation Score and Fecal Incontinence Severity Index at 3 and 12 months.
• Statistical analysis using Mann-Whitney U-test and Wilcoxon signed rank test; comparison with external rectal prolapse outcomes.

Main Results:

• LVR demonstrated acceptably low morbidity (4% minor) and short hospital stay (2 days).
• Significant improvements were observed in constipation (Wexner score from 12 to 4/5) and fecal incontinence (FISI score from 28 to 8) at 3 and 12 months (P < 0.0001).
• No patient experienced worsened functional outcomes; results were comparable to those for external rectal prolapse.

Conclusions:

• Laparoscopic ventral rectopexy is an effective short-term surgical treatment for internal rectal prolapse.
• LVR significantly alleviates symptoms of obstructed defecation and fecal incontinence.
• This study validates LVR as a nerve-sparing surgical approach for internal rectal prolapse.