Page 31 - World Journal of Laparoscopic Surgery

Laparoscopic Ventral Rectopexy for Rectal Prolapse
Follow-up the operation. Only one case (5%) was converted to open
Stool softeners were used for one month after operation along with rectopexy as dissection was lateral and pelvic vessels were
instructions to avoid constipation, lifting heavy objects, straining, exposed. Another patient (5%) reported postoperative pain
doing heavy exercise for 6 weeks, having sexual intercourse for 4 on defecation resulting from an acquired anal fissure during
weeks. Follow-up duration ranged from 6–12 months. preoperative preparation and it was managed conservatively.
Another patient (5%) complained of perianal maceration from
Statistical Analysis severe diarrhea. The third patient had prolonged postoperative
Data were presented as mean ± standard deviation, number, and ileus and initiated feeding on the fourth postoperative day. This
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percentages. Statistical analysis was performed using MedCalc patient was discharged home on the fifth day and returned to
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version 12.5 (MedCalc Software bvba, Ostend, Belgium) and the hospital with feeding intolerance.
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Microsoft Excel 2010 (Microsoft Corp., Redmond, Washington, • Recurrence: Recurrence of rectal prolapse after our procedure
USA). occurred in one patient (5%) that was managed with open
rectopexy (Table 1).
results
Demographic and Clinical Characteristics dIscussIon
We included 20 patients suffering from CRP who underwent All patients presented with RP during the period of the study.
LVMR. The patients were admitted from the outpatient clinic in Twenty patients who had complete persistent rectal prolapse or
Fayoum University Hospital in the period from 2015 to 2017. The recurring after previous interventions were subjected to an anterior
average age of patients was 34.4 ± 19.8 (range: 8–70) years. There approach of laparoscopic rectopexy. Male predominance was
was male predominance. We included 15 male patients (75%) and noted in our study, which was also noted in Potter et al., Flum et al.,
5 female patients (25%). The baseline preoperative symptoms were Laituri et al., and Chan et al. 23–25 In pediatrics, rectal prolapse affects
constipation in 35% of patients, urine incontinence in 5% of patients, equally males and females. The disease is much more common in
inflammation and ulceration by colonoscopy in 30% of patients. underdeveloped countries, with common causes including parasitic
Baseline demographic data are illustrated in detail in Table 1. disease, malnutrition, and diarrheal illness. 13
Twelve patients had no associated comorbidities. Patients tend
Primary Outcomes to strain vigorously against closed sphincters, leading eventually
• Constipation: Seven patients were constipated preoperatively to prolapse. Some authors considered that prolongation of
(35%). There was a significant postoperative improvement of the conservative treatment time is inappropriate because it is
patients with constipation. All patients reported an absence of distressing for patients with unlikeliness of response. Therefore,
constipation (100%) after the operation. early surgical intervention was considered more appropriate in
• Urine incontinence: Only one patient complained of urinary such cases. 27,28 In the study by Potter et al., 47% of patients had no
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incontinence before operation. There was no effect on the predisposing factors Also, in Flum et al., 62% of patients had no
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continence of patients. After the operation, there was one predisposing factors. However, meticulous history taking and
patient still complaining of urinary incontinence. thorough re-examination were done to pick up any predisposing
• Inflammation and ulceration by colonoscopy: There was a factor that would have been missed. Other treatable predisposing
significant improvement of inflammation and ulceration after factors such as constipation, diarrhea, and malnutrition were
the operation. All patients showed complete healing of the colon managed by stool softeners and diet modification (Fig. 3).
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after our approach. Laituri et al. in 2010 reported that extensive evaluation is not
• Operative complications: There was no bowel injury, nerve necessary in most uncomplicated cases as evaluation of patients
injury, major blood loss, or mesh erosion that occurred during with RP is relatively straightforward. However, we had baseline

Table 1: Baseline demographic data of 20 patients with CRP
Number (%) 20 (100%)
Age (mean ± SD) 34.4 ± 19.8
Sex (male:female) 15:5
Constipation n (%) 7 (35%)
Urine incontinence n (%) 1 (5%)
Inflammation and ulceration n (%) 6 (30%)
Previous surgery rectal prolapse n (%) 4 (20%)
Barium enema abnormalities n (%) 0 (0%)
Conversion to open surgery n (%) 1 (5%)
Average operating time (minute) 75 (60–90)
Follow-up duration range (month) 6:12
Average hospital stay (days) 3 (1–5) Fig. 3: Severe rectal prolapse with clinically significant edema and
n, number; SD, standard deviation mucosal ulceration

World Journal of Laparoscopic Surgery, Volume 15 Issue 3 (September–December 2022) 217