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Robot-Assisted Ventral Mesh Rectopexy for Rectal Prolapse: A 5-Year Experience at a Tertiary Referral Center

van Iersel, Jan J. M.D., Ph.D.1,2; Formijne Jonkers, Hendrik A. M.D., Ph.D.1; Paulides, Tim J.C. M.D.1; Verheijen, Paul M. M.D., Ph.D.1; Draaisma, Werner A. M.D., Ph.D.1; Consten, Esther C.J. M.D., Ph.D.1; Broeders, Ivo A.M.J. M.D., Ph.D.1,2

doi: 10.1097/DCR.0000000000000895
Original Contributions: Pelvic Floor
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BACKGROUND: Laparoscopic ventral mesh rectopexy is being increasingly performed internationally to treat rectal prolapse syndromes. Robotic assistance appears advantageous for this procedure, but literature regarding robot-assisted ventral mesh rectopexy is limited.

OBJECTIVE: The primary objective of this study was to assess the safety and effectiveness of robot-assisted ventral mesh rectopexy in the largest consecutive series of patients to date.

DESIGN: This study is a retrospective cross-sectional analysis of prospectively collected data.

SETTINGS: The study was conducted in a tertiary referral center.

PATIENTS: All of the patients undergoing robot-assisted ventral mesh rectopexy for rectal prolapse syndromes between 2010 and 2015 were evaluated.

MAIN OUTCOME MEASURES: Preoperative and postoperative (mesh and nonmesh) morbidity and functional outcome were analyzed. The actuarial recurrence rates were calculated using the Kaplan–Meier method.

RESULTS: A total of 258 patients underwent robot-assisted ventral mesh rectopexy (mean ± SD follow-up = 23.5 ± 21.8 mo; range, 0.2 – 65.1 mo). There were no conversions and only 5 intraoperative complications (1.9%). Mortality (0.4%) and major (1.9%) and minor (<30 d) early morbidity (7.0%) were acceptably low. Only 1 (1.3%) mesh-related complication (asymptomatic vaginal mesh erosion) was observed. A significant improvement in obstructed defecation (78.6%) and fecal incontinence (63.7%) were achieved for patients (both p < 0.0005). At final follow-up, a new onset of fecal incontinence and obstructed defecation was induced or worsened in 3.9% and 0.4%. The actuarial 5-year external rectal prolapse and internal rectal prolapse recurrence rates were 12.9% and 10.4%.

LIMITATIONS: This was a retrospective study including patients with minimal follow-up. No validated scores were used to assess function. The study was monocentric, and there was no control group.

CONCLUSIONS: Robot-assisted ventral mesh rectopexy is a safe and effective technique to treat rectal prolapse syndromes, providing an acceptable recurrence rate and good symptomatic relief with minimal morbidity. See Video Abstract at http://links.lww.com/DCR/A427.

1 Department of Surgery, Meander Medical Centre, Amersfoort, the Netherlands

2 Faculty of Science and Technology, Institute of Technical Medicine, Twente University, Enschede, the Netherlands

Funding/Support: None reported.

Financial Disclosure: None reported.

Correspondence: Ivo V.M.J. Broeders, M.D., Ph.D., Meander Medical Centre, Department of Surgery, Maatweg 3, 3813 TZ Amersfoort, the Netherlands. E-mail: IAMJ.Broeders@meandermc.nl

© 2017 The American Society of Colon and Rectal Surgeons