Anterior rectopexy for full-thickness rectal prolapse: Technical and functional results

Abstract

Aim: To assess effectiveness, complications, recurrence rate, and recent improvements of the anterior rectopexy procedure for treatment of total rectal prolapse.

Methods: MEDLINE, PubMed, EMBASE, and other relevant database were searched to identify studies. Randomized controlled trials, non-randomized studies and original articles in English language, with more than 10 patients who underwent laparoscopic ventral rectopexy for full-thickness rectal prolapse, with a follow-up over 3 mo were considered for the review.

Results: Twelve non-randomized case series studies with 574 patients were included in the review. No surgical mortality was described. Conversion was needed in 17 cases (2.9%), most often due to difficult adhesiolysis. Twenty eight patients (4.8%) presented with major complications. Seven (1.2%) mesh-related complications were reported. Most frequent complications were urinary tract infection and urinary retention. Mean recurrence rate was 4.7% with a median follow-up of 23 mo. Improvement of constipation ranged from 3%-72% of the patients and worsening or new onset occurred in 0%-20%. Incontinence improved in 31%-84% patients who presented fecal incontinence at various stages. Evaluation of functional score was disparate between studies.

Conclusion: Based on the low long-term recurrence rate and favorable outcome data in terms of low de novo constipation rate, improvement of anal incontinence, and low complications rate, laparoscopic anterior rectopexy seems to emerge as an efficient procedure for the treatment of patients with total rectal prolapse.

Keywords: Anterior rectopexy; Laparoscopy; Recurrence; Results; Systematic review; Total rectal prolapse; Ventral rectopexy.

Figures

Figure 1

Selection of studies for the review.

Figure 2

Type of complications. Horizontal axis for complications; Vertical axis for number of patients.

Figure 3

Severity of complications following Dindo Clavien classification. Adapted from Dindo et al Classification of surgical complication. Ann Surg 2004; 240: 205-213. Horizontal axis for Dindo Clavien grade; Vertical axis for number of patients.