Page 53 - World Journal of Laparoscopic Surgery

RESEARCH ARTICLE
Comparison between Laparoscopic Ventral and Posterior

Mesh Rectopexy for Rectal Prolapse

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Mostafa M Sayed , Hesham A Reyad , Mohamed Korany , Ibrahim M Abdelaal 4
Received on: 01 September 2021; Accepted on: 06 September 2022; Published on: 07 December 2022
AbstrAct
Aim: Recently, laparoscopic techniques are widely used for treatment of rectal prolapse. Therefore, the present work aims to compare the results
between laparoscopic ventral mesh rectopexy (LVMR) and laparoscopic posterior mesh rectopexy (LPMR) for patients suffering from rectal prolapse.
Materials and methods: This prospective study included forty-four patients with rectal prolapse admitted and managed at the Assiut University
Hospitals (Assiut, Egypt) in the period between November 2016 and 31 December 2020. They were divided into two groups (22 patients in
each group). Operative parameters, complications, length of hospital stay, postoperative improvement of constipation and fecal incontinence,
as well as recurrence were investigated. Clinical symptoms were followed up after surgery with the mean period of 23.73 ± 14.817 months.
Results: In the presented study, the mean patient age was 42.43 ± 14.05 years. There were 14 males (6 in the LPMR group vs 8 in the LVMR group)
and 30 females (16 for LPMR vs 14 for LVMR) without a significant difference in-between. Operative time was shorter in LPMR (114.09 ± 12.690
minutes) compared with LVMR (181.82 ± 15.395 minutes). No postoperative complications were observed in 81.82% of patients who underwent
LPMR and 90.91% of patients who underwent LVMR. Patients who underwent LVMR showed no impotence. Wexner’s constipation score was
postoperatively lower in LVMR than in LPMR (6.71 ± 3.29 vs 10.78 ± 2.80; respectively) indicating the significant improvement of constipation
in LVMR compared with LPMR. A significant improvement of the symptoms of obstructed defecation syndrome was observed in both groups
(p-value = 0.0001). Gastrointestinal quality-of-life score was highly increased from 66.09 ± 9.59 to 114.23 ± 8.64 after LVMR.
Conclusion: Our study proves that LVMR is superior to LPMR in prevention of impotence, improvement of constipation as well enhancement
of the quality of life. Thus, LVMR offers a safer and more effective approach for patients of all ages.
Keywords: Laparoscopic posterior mesh rectopexy, Laparoscopic ventral mesh rectopexy, Rectal prolapse.
World Journal of Laparoscopic Surgery (2022): 10.5005/jp-journals-10033-1534

IntroductIon 1–4 Department of General Surgery, Faculty of Medicine, Assiut
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Rectal prolapse is more common in females and increases with age. University, Assiut, Egypt
Rectal prolapse is either external or internal. External rectal prolapse Corresponding Author: Ibrahim M Abdelaal, Department of General
is a circumferential protrusion of all layers of the rectum over the Surgery, Faculty of Medicine, Assiut University, Assiut, Egypt, Phone:
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anal sphincter. Internal rectal prolapse, as well denoted to as rectal +201140024448, e-mail: ibrahim.mostafa@aun.edu.eg
intussusception or occult rectal prolapse, appears to be a pioneer of How to cite this article: Sayed MM, Reyad HA, Korany M, et al.
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external rectal prolapse. Many patients with rectal prolapse suffer Comparison between Laparoscopic Ventral and Posterior Mesh
from symptoms of constipation and fecal incontinence, leading to Rectopexy for Rectal Prolapse. World J Lap Surg 2022;15(3):239–245.
a significant negative impact on quality of life. 3 Source of support: This study was approved by Assiut University
Two approaches are probable. The perineal approach is related Protocol ID: AssiutU4988 and registered at ClinicalTrials.gov

to a high recurrence rate. So, it is preferred for patients who are ClinicalTrials ID: NCT03026738
not candidates for an abdominal operation. Currently, the abdominal Conflict of interest: None
procedures convey a lower recurrence rate and improved functional
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outcome and they are favored over the perineal procedures.
The objectives of the surgical management are to correct Hence, the objective of this study is to compare the results
the anatomical abnormality and to remedy the accompanying between LVMR and LPMR for patients admitted to Assiut University
symptoms of incontinence, pain, and constipation, with the lowest Hospital (Assiut, Egypt) with rectal prolapse, including recurrence,
rate of complications and a reasonable recurrence rate. 4 improvement of incontinence and constipation, operative time,
Laparoscopic procedures for the management of rectal prolapse and to assess the complications of both techniques.
have been applied in patients of all ages. Laparoscopic rectopexy
is safe and effective in patients of all ages and offers a lower rate of MAterIAls And Methods
postoperative surgical site infection and length of hospital stay. 3 This is a prospective study of forty-four cases of patients with rectal
Laparoscopic ventral mesh rectopexy is widely used, especially prolapse admitted and managed at the Assiut University Hospitals
in Europe. In 2004, this procedure was first described by Lundby in the period between November 2016 and 31 December 2020.
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and Laurberg. The technique relies on correcting the descent Patients were divided into two groups (22 patients per group):
of the posterior and middle pelvic compartments coupled
with reinforcement of the vaginal septum and elevation of the • Group A had LPMR.
pelvic floor. 6 • Group B had LVMR.

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