Functional outcomes and recurrence following laparoscopic ventral versus posterior mesh rectopexy for full thickness...

Full-thickness rectal prolapse (FTRP) significantly reduces quality of life due to the debilitating constipation and fecal incontinence. Laparoscopic ventral mesh rectopexy (LVMR) and laparoscopic posterior mesh rectopexy (LPMR) are two common abdominal approaches globally practiced. However, comparative data from South Asia is still scarce. The purpose of this study was to compare recurrence and functional outcomes after LVMR versus LPMR. A prospective, non-randomized comparative cohort study was carried out at a tertiary care facility, including patients who underwent laparoscopic mesh rectopexy for FTRP between January 2023 and June 2024, followed for 12 months and follow-up was completed in June 2025. Baseline demographics were comparable between groups. The Cleveland Clinic Constipation Score (CCCS) and Wexner Fecal Incontinence Score (FIS) were used to measure functional outcomes. Recurrence at 12 months was the primary outcome. Functional improvement (ΔCCCS, ΔFIS), operative parameters, and perioperative morbidity were secondary outcomes. SPSS version 25 was used to perform statistical analysis, and p < 0.05 was considered statistically significant. Sixty-five patients with comparable baseline demographics were analyzed (LVMR n = 32; LPMR n = 33). 3.1% (n = 1) of LVMR and none of LPMR patients experienced recurrence at 12 months (p = 0.492) with absolute risk difference of 3.1% points (95% CI, - 9.9 to 15.7). Given the single recurrence event, the comparative analysis of recurrence was considered exploratory. The LVMR group had a considerably longer operative time (188.8 ± 7.0 vs. 120.9 ± 10.2 min, p < 0.001). At 12 months, both approaches showed a significant within-group improvement in CCCS and FIS (p < 0.001). Greater improvement in functional scores was shown in LVMR group (ΔCCCS 8.75 ± 1.76 vs. 7.21 ± 1.54, p < 0.001; ΔFIS 6.72 ± 1.53 vs. 5.58 ± 1.58, p = 0.004) than in the LPMR group, with between-group differences of 1.54 and 1.14 points, respectively. The incidence of complications, length of hospital stay, and estimated blood loss did not differ considerably between groups. Our results are consistent with global literature indicating better improvement in functional recovery scores with LVMR, most likely as a result of avoiding posterior rectal mobilization and preserving autonomic nerves. Improved constipation and continence scores support the ventral approach, despite the longer operative time. However, both techniques are safe choices. For FTRP, both LVMR and LPMR are safe and effective techniques. LVMR is associated with greater improvement in functional scores, while no statistically considerable difference in postoperative complications is observed between the groups, while LPMR offers a shorter operative duration. Given the low number of events, recurrence findings are interpreted as exploratory outcome. There is still a need for larger prospective studies.