Page 29 - World Journal of Laparoscopic Surgery

ORIGINAL ARTICLE
Short-term Outcomes of Laparoscopic Ventral Approach

of Rectopexy with Polypropylene Mesh for Rectal Prolapse

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Ayman M Essawy , Ahmed E Fares , Ashraf M Thabet , Khaled M Bauomie 4
Received on: 22 April 2022; Accepted on: 14 May 2022; Published on: 07 December 2022
AbstrAct
Background: Complete rectal prolapse (CRP) is a disease in which all layers of the rectum herniate through the anal sphincter. Patients with
CRP may complain of constipation which precedes the prolapse.
Aim of the study: To evaluate the efficacy of laparoscopic ventral mesh rectopexy (LVMR) in the management of CRP.
Patients and methods: This trial was conducted on 20 patients with rectal prolapse (RP) who underwent LVMR admitted from the general
surgery outpatient clinic in Fayoum University Hospital in the period from July 2015 to December 2017.
Results: We included 15 male patients (75%) and 5 female patients (25%), the average age of participants was 34.4 years. There was a significant
improvement in constipation and inflammation and ulceration postoperatively. Recurrence occurred in one patient (5%).
Conclusion: The utilization of an anterior approach of laparoscopic technique is the approach of choice for patients with full-thickness RP.
The LVMR has the advantage of avoiding unnecessary repeated operations with all its physical and psychological effects on patients, minimal
recurrence, a high success rate, and a low complication rate for this procedure.
Keywords: Laparoscopy, Polypropylene mesh, Rectal prolapse, Rectopexy.
World Journal of Laparoscopic Surgery (2022): 10.5005/jp-journals-10033-1538

IntroductIon 1–4 Department of General Surgery, Faculty of Medicine, Fayoum
Rectal prolapse is classified according to its severity into the University, Fayoum, Egypt
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following three major grades: (i) Mucosal prolapse is a disease Corresponding Author: Khaled M Bauomie, Department of General
in which the mucosal lining of the rectum protrudes through the Surgery, Faculty of Medicine, Fayoum University, Fayoum, Egypt,
anus. (ii) Internal prolapse, rectal intussusception, in which part of Phone: +201024260661, e-mail: kbauomie@yahoo.com
the rectal wall invaginates into the lumen of another part of the How to cite this article: Essawy AM, Fares AE, Thabet AM, et al. Short-
rectum. (iii) The third grade is complete prolapse of the rectum term Outcomes of Laparoscopic Ventral Approach of Rectopexy
through the anus. 2–4 with Polypropylene Mesh for Rectal Prolapse. World J Lap Surg
Complete rectal prolapse is disease in which all layers of the 2022;15(3):215–219.
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rectum herniate through the anal sphincter. Complete rectal Source of support: Nil
prolapse is a disabling disease affecting about 2.5 individuals Conflict of interest: None
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per 100,000 population. The exact etiology of rectal prolapse
is unknown, however. Straight rectum, weakness of pelvic floor
muscles and anal sphincter, and lack of ligamentous support of the the perineal approach is preferable for old patients who are
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rectum are considered anatomical predisposing factors for CRP. A unfit for abdominal procedures. Laparoscopic correction of RP
mass protruding from the anus is the main clinical feature of the CRP. includes rectopexy and/or resection rectopexy. Laparoscopic
At first, the prolapse occurs after defecation, but with time it may ventral mesh rectopexy has been popularized in the past
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occur spontaneously upon standing or coughing. Incontinence is decade because of its benefits over alternative surgical options.
a frequent disabling symptom affecting about half of the patients Laparoscopic ventral mesh rectopexy is associated with better
with CRP. 5,9,10 The prolapsed rectum damages the rectal nerves anatomical results, fewer complications, less recurrence rate, and
and sphincters, which in turn, may lead to fecal incontinence not low mesh-related morbidity. 20,21 The ventral approach avoids the
resolving after surgery. 10 circumferential mobilization which decreases the complications of
The long history of constipation is defined as the most reported rectal denervation. 22
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complaint among patients with CRP. Weakness of the pelvic Our aim in this study was to measure the success and suitability
muscles by chronic straining may contribute to rectal prolapse. of the anterior approach of laparoscopic rectopexy for the
Surgical intervention is the treatment of choice of CRP in adults. 12,13 treatment of CRP.
The surgery aims to restore normal physiology and anatomy by
correcting the prolapse. 14,15 It also improves bowel and sexual PAtIents And Methods
function. Many surgical procedures have been suggested to treat
CRP. Available surgical treatment options include abdominal and Study Design
perineal approaches. 16,17 Abdominal approaches either open or The current clinical trial was conducted in general surgery
laparoscopic are better for young fit patients. On the other hand, outpatient clinic in Fayoum University Hospital in the period from

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