title: Laparoscopic ventral rectopexy in male patients with external rectal prolapse is associated with a high reoperation rate.
abstract: BACKGROUND
  Laparoscopic ventral rectopexy has been used to treat male patients with external rectal prolapse, but evidence to support this approach is scarce. The aim of this study was to evaluate the results of this new abdominal rectopexy surgical technique in men.
  
  
  METHODS
  This was a retrospective multicenter study. Adult male patients who were operated on for external rectal prolapse using ventral rectopexy in five tertiary hospitals in Finland between 2006 and 2014 were included in the study. Patient demographics, detailed operative, postoperative and short-term follow-up data were collected from patient registers in participating hospitals. A questionnaire and informed consent form was sent to all patients. The questionnaire included scores for anal incontinence, obstructed defecation syndrome, urinary symptoms and sexual dysfunction. The main outcome measure was the incidence of recurrent rectal prolapse. Surgical morbidity, the need for surgical repair due to recurrent symptoms and functional outcomes were secondary outcome measures.
  
  
  RESULTS
  A total of 52 adult male patients with symptoms caused by external rectal prolapse underwent ventral rectopexy. The questionnaire response rate was 64.4 %. Baseline clinical characteristics and perioperative results were similar in the responder and non-responder groups. A total of 9 (17.3 %) patients faced complications. There were two (3.8 %) serious surgical complications during the 30-day period after surgery that necessitated reoperation. None of the complications were mesh related. Recurrence of the prolapse was noticed in nine patients (17 %), and postoperative mucosal anal prolapse symptoms persisted in 11 patients (21 %). As a result, the reoperation rate was high. Altogether, 17 patients (33 %) underwent reoperation during the follow-up period due to postoperative complications or recurrent rectal or mucosal prolapse. According to the postoperative questionnaire data, patients under 40 had good functional results in terms of anal continence, defecation, urinary functions and sexual activity.
  
  
  CONCLUSIONS
  Laparoscopic ventral rectopexy is a safe surgical procedure in male patients with external prolapse. However, a high overall reoperation rate was noticed due to recurrent rectal and residual mucosal prolapse. This suggests that the ventral rectopexy technique should be modified or combined with other abdominal or perineal methods when treating male rectal prolapse patients.
authors.affiliation: Division of Gastroenterology, Department of Surgery, Oulu University Hospital, Oulu, Finland. tero.rautio@ppshp.fi.|Medical Research Center Oulu, University of Oulu, Oulu, Finland. tero.rautio@ppshp.fi.
authors.forename: T
authors.initials: T
authors.lastname: Rautio
authors.affiliation: Division of Gastroenterology, Department of Surgery, Oulu University Hospital, Oulu, Finland.|Medical Research Center Oulu, University of Oulu, Oulu, Finland.
authors.forename: J
authors.initials: J
authors.lastname: Mäkelä-Kaikkonen
authors.affiliation: Division of Urology, Department of Surgery, University Hospital of Oulu, Oulu, Finland.
authors.forename: M
authors.initials: M
authors.lastname: Vaarala
authors.affiliation: Department of Surgery, Keski-Suomi Central Hospital, Jyväskylä, Finland.
authors.forename: M
authors.initials: M
authors.lastname: Kairaluoma
authors.affiliation: Department of Surgery, Kanta-Häme Central Hospital, Hämeenlinna, Finland.|Department of Surgery, University of Turku, Turku, Finland.
authors.forename: J
authors.initials: J
authors.lastname: Kössi
authors.affiliation: Department of Gastrointestinal Surgery, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: M
authors.initials: M
authors.lastname: Carpelan-Holmström
authors.affiliation: Department of Gastrointestinal Surgery, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: S
authors.initials: S
authors.lastname: Salmenkylä
authors.affiliation: Division of Gastroenterology, Department of Surgery, Oulu University Hospital, Oulu, Finland.|Medical Research Center Oulu, University of Oulu, Oulu, Finland.
authors.forename: P
authors.initials: P
authors.lastname: Ohtonen
authors.affiliation: Division of Gastroenterology, Department of Surgery, Oulu University Hospital, Oulu, Finland.|Medical Research Center Oulu, University of Oulu, Oulu, Finland.
authors.forename: J
authors.initials: J
authors.lastname: Mäkelä
mesh_terms: D000328:Adult; D013505:Digestive System Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D005242:Fecal Incontinence / Q000209:etiology / Q000601:surgery; D005387:Finland; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery*; D012005:Rectal Prolapse / Q000473:pathology / Q000601:surgery*; D012007:Rectum / Q000601:surgery; D012086:Reoperation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: Laparoscopic ventral rectopexy; Rectal prolapse