Laparoscopic ventral rectopexy for internal rectal prolapse using biological mesh: postoperative and short-term functional results.
BACKGROUND
Laparoscopic ventral mesh rectopexy is a novel procedure to correct internal and external rectal prolapse. Several authors have shown that this approach is safe and improves obstructive defaecation symptoms and faecal incontinence, without inducing new-onset constipation, possible after posterior rectopexy. Over the last decade, as for other procedures, biological meshes are used to correct pelvic floor disorders. Literature data are scant. In this study, we present our experience with this procedure using biological mesh.


METHODS
Prospectively collected data on laparoscopic ventral mesh rectopexy for internal rectal prolapse were analysed. All patients underwent preoperative evaluation with defaecating proctography and/or pelvic dynamic MRI, full colonoscopy, anal physiology studies and endo-anal ultrasound. End-points were to evaluate surgical complications and functional results of this technique such as changes in bowel function (Wexner Constipation Score and Faecal Incontinence Severity Index) at 3 and 6 months. Analysis was performed using Mann-Whitney U test for unpaired data and Wilcoxon signed rank test for paired data (two-sided p test).


RESULTS
Thirty-four consecutive patients underwent laparoscopic ventral mesh rectopexy (median age 59, range 25-78 years, mean follow-up was 12 months). Twenty-eight patients (82%) had a constipation score ≥ 5, while 14 (41%) a FISI score ≥ 10. Nine patients (26%) had mixed obstructed defaecation and faecal incontinence. One patient required conversion to open (3%). Median length of stay was 2 days. Overall complication rate was 23.5%. Preoperative constipation (median Wexner score 15) and faecal incontinence (median FISI score 12) improved significantly at 3 months (Wexner 5, FISI 5, both p < 0.001). Two patients experienced prolapse persistence or recurrence. No patients had function worsening or complained of sexual dysfunction.


CONCLUSIONS
Laparoscopic ventral mesh rectopexy using biological mesh for internal rectal prolapse is safe and effective in ameliorating symptoms of obstructed defaecation and faecal incontinence.
Department of Surgery, Policlinico Tor Vergata, University of Rome Tor Vergata, Viale Oxford 81, 00133, Rome, Italy. piersileri@yahoo.com
Pierpaolo
P
Sileri
Luana
L
Franceschilli
Elisabetta
E
de Luca
Sara
S
Lazzaro
Giulio P
GP
Angelucci
Valeria
V
Fiaschetti
Carolina
C
Pasecenic
Achille L
AL
Gaspari
D000328:Adult; D000368:Aged; D003113:Colonoscopy; D003672:Defecation / Q000502:physiology*; D019160:Endosonography; D005260:Female; D005500:Follow-Up Studies; D005772:Gastrointestinal Transit / Q000502:physiology*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D011446:Prospective Studies; D012005:Rectal Prolapse / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D013526:Surgical Mesh; D013997:Time Factors; D016896:Treatment Outcome