Laparoscopic ventral rectopexy for obstructed defecation syndrome.
BACKGROUND
Obstructed defecation remains a serious syndrome. Several procedures have been applied to treat it. A concomitant enterocele excludes some of these procedures, because of potential threat of damaging the bowel. The aim of this study was to assess the outcome of patients who underwent laparoscopic nerve sparing ventral rectopexy for obstructed defecation syndrome with concomitant enterocele.


METHODS
Seventeen patients were included. Data about clinical history, physical examination and a defecogram were collected. All patients underwent a laparoscopic ventral rectopexy. Complications, hospital stay, postoperative morbidity and long-term outcome were documented.


RESULTS
All patients underwent laparoscopic ventral rectopexy. The median operating time was 199 min (range 186-239 min). One conversion laparotomy was required. Six patients had postoperative complications (ileus n = 2, posttraumatic leg dystrophy n = 1, wound infection n = 1, incisional hernia n = 2). The median hospital stay was 6 days (range 3-24 days). Fifteen patients had improvement of their defecation problem, although six patients still had minor constipation symptoms. In one patient the mesh was rejected and finally removed.


CONCLUSIONS
Obstructed defecation syndrome is a combined functional and mechanical problem. In selected patients, especially when an enterocele is present, laparoscopic ventral rectopexy is a feasible technique, with an acceptable number of complications.
van den Esschert
J W
JW
Department of Surgery, Tergooi Ziekenhuizen, Van Riebeeckweg 212, Hilversum, 1213 XZ, The Netherlands. j.w.vandenesschert@amc.uva.nl
van Geloven
A A W
AA
Vermulst
N
N
Groenedijk
A G
AG
Groenedijk
A
A
de Wit
L Th
LT
Gerhards
M F
MF
D000328:Adult; D000368:Aged; D003248:Constipation / Q000209:etiology / Q000601:surgery; D052858:Cystocele / Q000150:complications; D003672:Defecation; D005242:Fecal Incontinence / Q000209:etiology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006547:Hernia / Q000150:complications*; D059685:Herniorrhaphy; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery*; D007418:Intestinal Pseudo-Obstruction / Q000209:etiology / Q000601:surgery*; D007443:Intussusception / Q000150:complications / Q000601:surgery; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000453:epidemiology; D012005:Rectal Prolapse / Q000150:complications / Q000601:surgery; D020047:Rectocele / Q000150:complications* / Q000601:surgery; D012007:Rectum / Q000601:surgery*; D012720:Severity of Illness Index; D013526:Surgical Mesh; D013536:Suture Techniques; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000150:complications; D014596:Uterine Prolapse / Q000150:complications