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Long-Term Functional Outcomes After Laparoscopic and Open Rectopexy for the Treatment of Rectal Prolapse

Byrne, Christopher M. M.B.B.S.(Hons.), B.Sc.(med.), M.S., F.R.A.C.S.; Smith, Steven R. M.B.B.S., B.Sc.(med.), M.S., F.R.A.C.S.; Solomon, Michael J. M.B.B.Ch.(Hons.), M.Sc.(Cl. Epid.), F.R.A.C.S.; Young, Jane M. Ph.D., M.P.H., M.B.B.S., F.A.F.P.H.M.; Eyers, Anthony A. M.B.B.S., M.Bioethics, F.R.C.S., F.R.A.C.S.; Young, Christopher J. M.B.B.S., M.S., F.R.A.C.S.
Diseases of the Colon & Rectum: November 2008
doi: 10.1007/s10350-008-9365-6
Original Contribution: PDF Only

Purpose: Purpose:Laparoscopic rectopexy to treat full-thickness rectal prolapse has proven short-term benefits, but there is little long-term follow-up and functional outcome data available.

Methods: Methods:Patients who had abdominal surgery for prolapse during a ten-year period were identified and interviewed to ascertain details of prolapse recurrence, constipation, incontinence, cosmesis, and satisfaction. Additional details on recurrences that required surgery and mortality were obtained from chart review and the State Death Registry.

Results: Results:Of 321 prolapse operations, laparoscopic rectopexy was performed in 126 patients, open rectopexy in 46, and resection rectopexy in 21 patients. At a median follow-up of five years after laparoscopic rectopexy, there were five (4 percent) confirmed full-thickness recurrences that required surgery. Actuarial recurrence rates of laparoscopic rectopexy were 6.9 percent at five years (95 percent confidence interval, 0.1-13.8 percent) and 10.8 percent at ten years (95 percent confidence interval, 0.9-20.1 percent). Seven patients underwent rubber band ligation for mucosal prolapse and seven required other surgical procedures. There was one recurrence after open rectopexy (2.4 percent) and one after resection rectopexy (4.7 percent), and there was no significant difference between groups. Overall constipation scores were not increased after laparoscopic rectopexy, with no significant difference to open rectopexy or resection rectopexy.

Conclusions: Conclusions:This study has demonstrated that laparoscopic rectopexy has reliable long-term results for treating rectal prolapse, including low recurrence rates and no overall change in functional outcomes.

Dr. Byrne was supported by the Notaras Fellowship from the University of Sydney, the Scientific Foundation of the Royal Australasian College of Surgeons and the training board of the Colorectal Society of Australasia.

Presented at the Tripartite Colorectal meeting, Dublin, Ireland, July 5 to 7, 2005.

Reprints are not available.

e-mail: msolomon@med.usyd.edu.au

© The ASCRS 2008