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Laparoscopic Ventral Rectopexy for Rectal Prolapse
            investigations for all patients which were stool culture, plain X-ray   spontaneously, which is the same limitation in most studies dealing
            abdomen, barium enema, and colonoscopy to assess the presence   with the RP.
            of any other pathologies and the fitness of patients. In 2010, Potter   The other limitation is the relatively short period of follow-up.
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            et al.  used colonoscopy or barium enema before operative   Subsequent studies with a longer follow-up period would be useful
            intervention for evaluation of rectum.             in accessing the success rate of the LVMR.
                         29
               Shalaby et al.  in their study used plain radiographs, barium   From the obtained results, we found that the anterior
            enema, proctoscopy, colonoscopy, and pre and postoperative EMG.   approach of laparoscopic rectopexy is a simple, minimally invasive
            We reserved the use of colonoscopy for adult cases of significant   technique, with reasonable operative time and minimal immediate
            bleeding per rectum or abnormalities detected on barium enemas.   postoperative morbidities.
            Similarly, EMG use was conserved for cases with the significantly
            diminished anal tone, as pelvic floor weakness, which is usually   Data Availability Statement
            seen in adults and rarely seen in children. 30     Data will be available to any researcher who contact the corre-
               Our operative time ranged 60–90 minutes with a mean of 75   sponding author.
                            23
            minutes. Potter et al.  had a range 28–117 minutes with a mean
                                 29
            of 72 minutes. Shalaby et al.  had a range 50–70 minutes with a  references
            mean of 60 minutes. Abdominal procedure via the laparoscopic     1.   Jones OM, Cunningham C, Lindsey I. The assessment and man-
            approach is now the recommended approach in all cases. There   agement of rectal prolapse, rectal intussusception, rectocele, and
            is a recurrence rate of 2–5% after laparoscopic sigmoid resection   enterocoele in adults. BMJ 2011;342:c7099. DOI: 10.1136/bmj.c7099.
                                31
            with or without rectopexy. Generally, in mesh rectopexy, there is     2.   Tsunoda A, Takahashi T, Yagi Y, et al. Rectal intussusception and
            a mobilization of the rectum to the pelvic floor with a ventral or a   external rectal prolapse are common at proctography in patients
            posterior application of the mesh. The circumferential mobilization   with mucus discharge. J Anus Rectum Colon 2018;2(4):139–144. DOI:
            of the rectum usually damages the autonomic supply of the   10.23922/jarc.2018-003.
            rectum, which in turn affect the motility of rectosigmoid yielding     3.   Blaker K, Anandam JL. Functional disorders: Rectoanal intussuscep-
                                                                    tion. Clin Colon Rectal Surg 2017;30(1):5–11. DOI: 10.1055/s-0036-
                                                       32
            de novo constipation or worsening of existing constipation.  Other   1593433.
            techniques that performed complete mobilization of the rectum,     4.   Tsiaoussis J, Chrysos E, Athanasakis E, et al. Rectoanal intussusception:
            were found to be unnecessary as good results were obtained   Presentation of the disorder and late results of resection rectopexy.
            without the need for complete mobilization. 33          Dis Colon Rectum 2005;48(4):838–844. DOI: 10.1007/s10350-004-
                                        20
               In 2006, D’Hoore and Penninckx  reported “nerve–sparing   0850-2.
            ventral rectopexy” as a main procedure for the management of rectal     5.   Felt-Bersma RJF, Stella MTE, Cuesta MA. Rectal prolapse, rectal
            prolapse. The primary advantage of laparoscopic ventral rectopexy is   intussusception, rectocele, solitary rectal ulcer syndrome, and
            that it avoids any posterolateral dissection of the rectum keeping the   enterocele. Gastroenterol Clin North Am 2008. DOI:10.1016/j.gtc.
                                                                    2008.06.001.
            autonomic innervation intact. Nowadays, this technique has gained     6.   Felt-Bersma RJF, Cuesta MA. Rectal prolapse, rectal intussusception,
            widespread acceptance and is considered the standard method for   rectocele, and solitary rectal ulcer syndrome. Gastroenterol Clin
                                   34
            treating pelvic organ prolapse.  The benefits of the laparoscopic   North Am 2001;37(3):645–668, ix. DOI: 10.1016/j.gtc.2008.06.001.
            approach and anterior approach of rectopexy have made the      7.   Kairaluoma MV, Kellokumpu IH. Epidemiologic aspects of complete
            procedure effective and safe with minimal functional disturbance.   rectal prolapse. Scand J Surg 2005;94(3):207–210. DOI: 10.1177/
               Many published studies reported a recurrence rate of 5%   145749690509400306.
            following LVMR. These recurrences usually occur within the first     8.   Vogler SA. Rectal Prolapse. Dis Colon Rectum 2017;60(11):1132–1135.
                                                                    DOI: 10.1097/DCR.0000000000000955.
            2–3 years. 21,35  The risk of recurrence is similar to that reported for     9.   Jacobs LK, Lin YJ, Orkin BA. The best operation for rectal prolapse.
                                       36
            other abdominal procedures 2–9%.  The overall Recurrence, in   Surg Clin North Am 1997;77(1):49–70. DOI: 10.1016/s0039-6109(05)
            our study, is one out of 20 patients 5% that is being managed with   70532-6.
            open rectopexy and improved on follow-up. Laparoscopic ventral     10.   Roig JV, Buch E, Alós R, et al. Anorectal function in patients with
            mesh rectopexy is associated with a lower incidence of recent–onset   complete rectal prolapse. Differences between continent and
            constipation. Besides, it shows a great improvement in pre-existing   incontinent individuals. Rev Esp Enfermedades Dig 1998;90(11):
            constipation as compared with posterior rectal dissection.  794–805. PMID: 9866412.
               Three randomized trials have shown an improvement in     11.   Yoon SG. Rectal prolapse: Review according to the personal
            constipation by avoiding lateral and posterior dissection. 37–39  experience. J Korean Soc Coloproctol 2011;27(3):107–113. DOI: 10.3393/
                                                                    jksc.2011.27.3.107.
               Postoperative dyschezia and constipation were reported in     12.   Cannon JA. Evaluation, diagnosis, and medical management of rectal
            many case series. 29,40  These postoperative symptoms were not   prolapse. Clin Colon Rectal Surg 2017;0(1):16–21. DOI: 10.1055/s-0036-
            encountered in our study, which is attributed to the avoidance of   1593431.
            retro rectal dissection.                             13.   Rentea RM, St. Peter SD. Pediatric rectal prolapse. Clin Colon Rectal
               One can argue that the utilization of an anterior approach   Surg 2018;31(2):108–116. DOI: 10.1055/s-0037-1609025.
            of laparoscopic technique is the approach of choice for patients     14.   Perier P, Hohenberger W, Lakew F, et al. Prolapse of the posterior
            with full-thickness RP. The LVMR has the advantage of avoiding   leaflet: Resect or respect. Ann Cardiothorac Surg 2015;4(3):273–277.
            the unnecessary repeated operations with all its physical and   DOI: 10.3978/j.issn.2225-319X.2014.11.16.
            psychological effect on patients, minimal recurrence, the high     15.   Antunes MJ. Revisiting posterior mitral leaflet prolapse: Resect, respect,
            success rate, and low complication rate for this procedure.  or resect with respect? J Thorac Cardiovasc Surg 2018;155(2):602–603.
                                                                    DOI: 10.1016/j.jtcvs.2017.10.038.
               Study limitations were the relatively small number of patients,     16.   Saadai P, Trappey AF, Langer JL. Surgical management of rectal
            but this could be attributed to the characteristics of the disease   prolapse in infants and children. Eur J Pediatr Surg 2020;30(5):
            in children and the fact that a big number of patients resolve   401–405. DOI: 10.1055/s-0040-1716725.



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