Laparoscopic-total extraperitoneal anterior rectopexy (L-TEAR)-a preliminary report

Complete rectal prolapse, associated incontinence and obstructive symptoms, significantly impairs quality of life. Minimally invasive ventral mesh rectopexy, the current standard, being transperitoneal, entails risks of vascular, bowel injury, and adhesions, besides mesh and tack fixation issues. This study evaluates the feasibility, safety, and short-term outcomes of a novel total extraperitoneal anterior rectopexy that avoids peritoneal transgression and sacral fixation.

In this prospective single-center study conducted from July 2024 through the time of publishing, 20 patients (11 male, 9 female; mean age 34.6 ± 14.2 years) with complete rectal prolapse who had a body mass index < 28 kg/m² and who had not had prior abdominal surgery underwent this procedure, which involved transfascial rectal fixation to the abdominal wall with preperitoneal mesh placement. Operative variables, complications, recurrence, functional outcomes [St. Mark's Incontinence Score (SMIS), obstructed defecation syndrome (ODS) score, quality-of-life questionnaires], sigmoidoscopy, manometry, and defecography were assessed.

Mean operative time was 181.2 ± 41.6 min, blood loss 70.6 ± 30.6 mL, and hospital stay 4.1 ± 2.7 days. During median 8-month follow-up, two patients (10%) experienced mucosal prolapse. There was no mortality nor were there major complications. Four patients developed transient hematuria, resolving conservatively. Significant improvements were observed in SMIS (18.6 ± 2.4 to 14.4 ± 2.8; p = 0.0357) and ODS scores (16.3 ± 3.2 to 8.1 ± 3.9; p < 0.0001). Quality-of-life improved, while manometric and defecographic parameters were not significantly altered.

Total extraperitoneal anterior rectopexy is feasible and safe, avoiding peritoneal entry and sacral fixation while achieving favorable early outcomes. Larger, long-term validation is needed.