title: New-onset rectoanal intussusception may not result in symptomatic improvement after laparoscopic ventral rectopexy for external rectal prolapse.
abstract: BACKGROUND
  This study was designed to assess defecatory function in patients who underwent laparoscopic ventral rectopexy (LVR) for external rectal prolapse (ERP).
  
  
  METHODS
  Thirty-one patients who underwent evacuation proctography 6 months postoperatively were assessed. Preoperative proctography had been performed in 21 patients of these patients. Defecatory function was evaluated using the constipation scoring system (CSS) and fecal incontinence severity index (FISI).
  
  
  RESULTS
  The findings of postoperative proctography revealed no full-thickness ERP in any patient, although in 10 patients the ERP was replaced by rectoanal intussusception (RAI). Of the 31 patients, 30 presented with fecal incontinence preoperatively. Ten of 30 had new-onset RAI. Six months postoperatively, a reduction of at least 50 % in the FISI score of the patients with new-onset RAI tended to be significantly smaller than in the patients without RAI (6/10 vs. 18/20, p = 0.141). Seventeen patients presented with obstructed defecation preoperatively. Seven of them had new-onset RAI. Six months postoperatively, a reduction of at least 50 % in their CSS score in the patients with new-onset RAI was significantly smaller than in patients without RAI (0/7 vs. 8/10, p = 0.002).
  
  
  CONCLUSIONS
  Evacuation proctography showed new-onset RAI in some patients with ERP who underwent LVR, which was associated with a lack of symptomatic improvement.
authors.affiliation: Department of Gastroenterological Surgery, Kameda Medical Center, 929 Higashi-cho, Kamogawa City, Chiba, 296-8602, Japan. tsunoda.akira@kameda.jp.
authors.forename: A
authors.initials: A
authors.lastname: Tsunoda
authors.affiliation: Department of Gastroenterological Surgery, Kameda Medical Center, 929 Higashi-cho, Kamogawa City, Chiba, 296-8602, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Takahashi
authors.affiliation: Department of Gastroenterological Surgery, Kameda Medical Center, 929 Higashi-cho, Kamogawa City, Chiba, 296-8602, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Ohta
authors.affiliation: Department of Gastroenterological Surgery, Kameda Medical Center, 929 Higashi-cho, Kamogawa City, Chiba, 296-8602, Japan.
authors.forename: W
authors.initials: W
authors.lastname: Fujii
authors.affiliation: Department of Gastroenterological Surgery, Kameda Medical Center, 929 Higashi-cho, Kamogawa City, Chiba, 296-8602, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Kusanagi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003248:Constipation / Q000000981:diagnostic imaging / Q000209:etiology; D003672:Defecation / Q000502:physiology; D019841:Defecography / Q000379:methods; D013505:Digestive System Surgical Procedures / Q000379:methods; D005242:Fecal Incontinence / Q000000981:diagnostic imaging / Q000209:etiology; D005260:Female; D006801:Humans; D007443:Intussusception / Q000209:etiology*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D012002:Rectal Diseases / Q000209:etiology*; D012005:Rectal Prolapse / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D012720:Severity of Illness Index
keywords: Evacuation proctography; External rectal prolapse; Laparoscopic ventral rectopexy