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Risk Factors for Recurrence After Laparoscopic Ventral Rectopexy
Cherylin W P Fu1, Andrew R L Stevenson
11 Department of Colorectal Surgery, Singapore General Hospital, Singapore 2 Department of Colorectal Surgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia 3 Faculty of Medicine and Biomedical Sciences, University of Queensland, Brisbane, Queensland, Australia.
Diseases of the Colon and Rectum
|January 7, 2017
Summary
Recurrence after laparoscopic ventral rectopexy is multifactorial. Biologic grafts and avoiding mesh complications reduce recurrence risk in patients with full-thickness rectal prolapse.
Area of Science:
- Gastroenterology and Surgical Innovation
- Pelvic Floor Disorders
- Minimally Invasive Surgery
Background:
- Laparoscopic ventral rectopexy is a primary treatment for posterior compartment prolapse.
- Understanding recurrence factors is crucial for improving patient outcomes.
Purpose of the Study:
- To identify clinical and technical factors predicting recurrence after laparoscopic ventral rectopexy.
- To analyze differences in recurrence rates based on prolapse type and surgical materials.
Main Methods:
- Retrospective cohort analysis of 231 patients undergoing laparoscopic ventral rectopexy (June 2008 - June 2014).
- Cox proportional hazards regression used to determine recurrence predictors.
- Comparison of patients with full-thickness rectal prolapse versus other types.
Main Results:
- Overall recurrence rate was 11.7%, with higher rates in full-thickness prolapse (14.2%).
- Predictors for recurrence included prolonged pudendal nerve terminal motor latency and use of synthetic mesh.
- Technical failures involved mesh detachment and inadequate fixation.
Conclusions:
- Recurrence is multifactorial, influenced by patient factors and surgical technique.
- Biologic grafts showed lower recurrence rates than synthetic mesh.
- Elderly patients with full-thickness prolapse, poor continence, and prolonged nerve latency face higher recurrence risk.
