Laparoscopic ventral rectopexy: a prospective long-term evaluation of functional results and quality of life.
BACKGROUND
Laparoscopic ventral rectopexy for rectal prolapse combines the advantages of a minimally invasive approach with the low recurrence rate observed after abdominal procedures. To date, only a few long-term functional studies and no quality of life assessment are available. The aim of this study was to assess long-term functional outcomes and quality of life after laparoscopic ventral rectopexy.


METHODS
Between January 2007 and December 2008, patients who underwent laparoscopic ventral rectopexy for full-thickness external rectal prolapse and/or rectocele were prospectively included. Fecal incontinence and constipation were scored (Wexner score and Rome II criteria). Quality of life was assessed using the gastrointestinal quality of life form (GIQLI).


RESULTS
Thirty-three patients were included and 30 (91 %) completed all the questionnaires. There was no morbidity or mortality. The mean length of hospital stay was 5 ± 1 days (range 3-7 days). After a mean follow-up of 42 ± 7 months (range 32-52 months), recurrence of rectocele was observed in two patients (6 %). At the end of follow-up, constipation was improved in 13/18 patients (72 %) and two patients (7 %) presented de novo constipation. The patients' Wexner score improved between preoperative status and end of follow-up (12 ± 7 vs. 4 ± 3, p = 0.002). Compared to the preoperative score, quality of life significantly improved over time: 77 ± 21 preoperatively versus 107 ± 17 at 1 year versus 109 ± 18 at the end of follow-up (p < 0.001).


CONCLUSIONS
This prospective study showed that laparoscopic ventral rectopexy was associated with excellent postoperative outcomes and a low long-term recurrence rate. Long-term functional results were excellent in terms of continence, with significant improvement of quality of life and without worsening constipation.
Department of Colorectal Surgery, Pôle des Maladies de l'Appareil Digestif, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, University Denis Diderot (Paris VII), 100 boulevard du Général Leclerc, 92110 Clichy, France.
L
L
Maggiori
F
F
Bretagnol
M
M
Ferron
Y
Y
Panis
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003248:Constipation / Q000517:prevention & control; D005242:Fecal Incontinence / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011351:Proctoscopy / Q000379:methods; D011446:Prospective Studies; D011788:Quality of Life; D020127:Recovery of Function; D012005:Rectal Prolapse / Q000175:diagnosis / Q000601:surgery*; D020047:Rectocele / Q000175:diagnosis / Q000601:surgery*; D018570:Risk Assessment; D013526:Surgical Mesh; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome