Page 58 - World Journal of Laparoscopic Surgery

Laparoscopic Ventral vs Posterior Mesh Rectopexy for Rectal Prolapse
complications in both groups. Recurrence was found in 13.64% of are similar to a previous study that reported the improvement of
patients who underwent LPMR vs 4.54% of patients who underwent constipation (WCS fallen from 9 to 6) after LVMR. 9
LVMR. The previous studies recorded 0–21% of recurrent full- Furthermore, one patient of group B was not improved from
thickness rectal prolapse after LVMR. 3,9–15 incontinence. The postoperative decrease in BPS values in LPMR
MRI defecography was done for the patients in both groups and LVMR proved the improvement of incontinence. The change in
of our study who did not clinically improve. It was found that the both groups was statistically significant (p-value = 0.003 and 0.004
postoperative recurrence of the three patients who underwent for groups A and B; respectively).
LPMR became grades III, IV, and V. However, the patient who In a previous study, 27–90% of patients have shown an
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underwent LVMR suffered from grade III postoperative recurrence. improvement of fecal incontinence that improved after LVMR.
The recurrence might occur in elderly patients and multipara Also, Dyrberg et al. have confirmed a complete improvement of
women due to weak pelvic floor muscle. incontinence in 74.4% of patients followed up 60 days after LVMR
2
Moreover, one patient (4.54%) who underwent LVMR had and in 86.3% improved after LPMR. In conclusion, the restitution
discitis. Unlike LVMR, discitis was not reported as a postoperative mechanism could be assisted by the improvement in rectal
complication in LPMR. As a result, there were no significant compliance and anorectal sensation. Also, restoration of internal
differences in postoperative complications between the two groups anal sphincter function and postoperative constipation were
(p = 0.142). Our findings agree with those reported by Samaranayake important reasons for restitution. 24,25
et al. who observed discitis in two cases who underwent LVMR. 16 After applying ODSS, there was no difference between the
Impotence occurred in one patient (4.54%) who underwent results of both groups. A significant improvement of the symptoms
LPMR. No impotence was recorded for patients who underwent of obstructed defecation syndrome was observed in both groups
LVMR. Like our findings, no cases of impotence have been reported (p-value = 0.0001). These results agree with other reported
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for LVMR according to Owais et al. The risk of pelvic sympathetic studies 3,14,26 that stated that obstructed defecation syndrome
and parasympathetic nerve damage after LPMR is considered the deteriorated in 12 patients (75%) which was higher than our result
main cause of sexual dysfunction in men. 18,19 As reported, the risk (2 patients, 16.67% not improved). Defective rectal filling sensation,
of nerve injury should be less than 1–2% during the selection of functional and mechanical outlet obstruction, the consumption of
18
repair procedures, especially in men. Hence, our results assured force at straining, and severe rectal intussusception in addition to
that LVMR is better than LPMR in avoiding the pelvic nerve damage rectocele can lead to obstructed defecation.
and impotence. Additionally, GIQOL was applied. In LPMR, Gastrointestinal
Mesh erosion into the rectum or vagina is a reported compli- Quality of Life score was increased from 61.00 ± 8.01 to 105.45 ±
cation after laparoscopic rectopexy. The reported mesh-erosion 7.54 after surgery. While the score changed from 66.09 ± 9.59 to
20
rate ranged between 1 and 5%. Infection, pervious pelvic 114.23 ± 8.64 after LVMR. The improvement is more in the LVMR
irradiation, undiscovered vaginal injury, and large-size mesh that group, and the difference is clinically significant (p = 0.0001). About
21
folds after fixation are the common causes of mesh erosion. 77.78% of patients who underwent LPMR did not improve from
However, mesh erosion did not occur in the presented study, this constipation versus 17.65% of patients who underwent LVMR.
may be due to the absence of long-term follow-up after surgery. This might be the reason for the worsened life quality in LPMR
Concerning clinical changes after surgery, constipation, compared with LVMR.
obstructed defecation syndrome, and incontinence were followed
up for 6–50 months after surgery. In this study, improvement of conclusIon
constipation was higher in LVMR (82.35% improved) in comparison To summarize, laparoscopic rectopexy has been proved to be as
with LPMR (22.22% improved). Our results agreed with other effective as open rectopexy in rectal prolapse treatment with a
reported studies stating that LVMR was superior to LPMR because of low recurrence rate. Laparoscopic rectopexy is preferable than
the lower risk of nerve damage and postoperative constipation. 16,22 open abdominal rectopexy in the reduction of postoperative
We found that 82.35% of patients were improved from pain, hospital length of stay, recovery time, and postoperative
constipation after LVMR near other reported percentages (86%, complications. Also, our study proves that LVMR is superior to LPMR
97%, 81%, and 89%). 3,10–12 in prevention of impotence, improvement of constipation, as well
Regarding WCS, it was postoperatively lower in LVMR than LPMR as enhancement of the quality of life. Thus, laparoscopic rectopexy
(6.71 ± 3.29 vs 10.78 ± 2.80, respectively). These results indicate especially LVMR, offers an effective and safe approach for patients
the significant improvement of constipation in LVMR compared of all ages. However, more studies with a large number of cases
with LPMR. The postoperative constipation mechanisms might and long duration of follow-up are required to evaluate long-term
be due to: the leave of a redundant sigmoid colon that might consequences.
link to yield a mechanical obstruction or due to interruption of
the autonomic sympathetic innervation of the rectum, leading AcknowledgMents
to a hindgut denervation inertia and distal slow transit or due to
division of the lateral ligaments. Furthermore, the denervation The authors would like to thank Dr Noha M Hosny (lecturer of
inertia inconsistently dominates any mechanical improvement pharmaceutical analytical chemistry at Faculty of Pharmacy,
from fixation of the intussuscepting prolapse. This explained why Assiut University, Assiut, Egypt) for her valuable contribution
9
LPMR sometimes improves and other times worsens constipation to performing the statistical analysis of this study and editing–
Moreover, the basis of the postoperative constipation improvement reviewing this paper.
in LVMR is the restriction of the mobilization to anterior rectum that
leads to rectal intussusception and prevention of posterior and orcId
lateral rectal mobilization as well as denervation inertia. Our results Ibrahim M Abdelaal https://orcid.org/0000-0002-8942-8016

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