Laparoscopic anterior rectopexy for full thickness rectal prolapse: is it the answer?

Dr. Amit Gaur; Satish N C; Lalit Kumar; Nishant Pathak

Volume : IX, Issue : IV, April - 2019

Laparoscopic anterior rectopexy for full thickness rectal prolapse: is it the answer?

Dr. Amit Gaur, Satish N C, Lalit Kumar, Nishant Pathak

Abstract :

Background: The various procedures (perineal and abdominal) described for complete rectal prolapse differ in technique, peritoneal dissection (anterior/ posterior), use of mesh/ sutures/ tackers, sigmoid resection etc and so varying results in different studies. We assessed the effectiveness, complications and recurrence rate of laparoscopic anterior rectopexy (LAR). Materials and Method: All the confirmed cases of complete rectal prolapse who underwent LAR (D‘ Hoore modification, involving peritoneal incision and mesh fixation, proximally at sacral promontory and distally with left lateral rectal ligament) were considered for the study. MRI pelvis, colonoscopy and Pre– anaesthetic check–up was done and informed consent was taken from all. Exclusion Criteria: Patients unfit for abdominal surgeries/ general anaesthesia, those requiring conversion to open or sigmoid resection, preferring perineal procedure, having rectal gangrene, or uncontrolled psychiatric illness. Duration: (Feb 16 to Jun 18) Post–op follow–up: OPD basis (at least once at 6–12 weeks) & subsequently telephonically/ or SOS. Results: 12 underwent LAR, (11:male::01female), 7:serving personnel, mean duration of symptoms:4year(min:18mon::max:11year), mean age:43years (min:29::max:63), 4 had incontinence, 3 had blood spottings, 6 had Constipation, & 1 had pain pre–op. Two had recurrence after previous perineal surgeries. Mean op time:2hr12minutes(min:1hr24 minute::max:3hr04minutes). We had nil conversion, recurrence or complications over mean follow–up of 14 months. Improvement occurred in all cases of incontinence & bleeding per–rectum, and 4/6 cases of constipation. Conclusion: Laparoscopic anterior rectopexy may be considered as the procedure of choice for complete rectal prolapse, especially in serving personnel because of fast recovery and early return to work.