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Does Ventral Rectopexy Improve Pelvic Floor Function in the Long Term?

Mäkelä-Kaikkonen, Johanna, M.D.1,2; Rautio, Tero, M.D., Ph.D.1,2; Kairaluoma, Matti, M.D., Ph.D.3; Carpelan-Holmström, Monika, M.D., Ph.D.4; Kössi, Jyrki, M.D., Ph.D.5,6; Rautio, Anna, M.D.1,2; Ohtonen, Pasi, M.Sc.1,2; Mäkelä, Jyrki, M.D., Ph.D.1,2

doi: 10.1097/DCR.0000000000000974
Original Contributions: Pelvic Floor
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BACKGROUND: Information is needed on long-term functional results, sequelas, and outcome predictors for laparoscopic ventral mesh rectopexy.

OBJECTIVE: The purpose of this study was to evaluate long-term function postventral rectopexy in patients with external rectal prolapse or internal rectal prolapse in a large cohort and to identify the possible effects of patient-related factors and operative technical details on patient-reported outcomes.

DESIGN: This was a retrospective review with a cross-sectional questionnaire study.

SETTINGS: Data were collated from prospectively collected registries in 2 university and 2 central hospitals in Finland.

PATIENTS: All 508 consecutive patients treated with ventral rectopexy for external rectal prolapse or symptomatic internal rectal prolapse in 2005 to 2013 were included.

INTERVENTIONS: A questionnaire concerning disease-related symptoms and effect on quality of life was used.

MAIN OUTCOME MEASURES: Defecatory function measured by the Wexner score, the obstructive defecation score, and subjective symptom and quality-of-life evaluation using the visual analog scale were included. The effects of patient-related factors and operative technical details were assessed using multivariate analysis.

RESULTS: The questionnaire response rate was 70.7% (330/467 living patients) with a median follow-up time of 44 months. The mean Wexner scores were 7.0 (SD = 6.1) and 6.9 (SD = 5.6), and the mean obstructive defecation scores were 9.7 (SD = 7.6) and 12.3 (SD = 8.0) for patients presenting with external rectal prolapse and internal rectal prolapse. Subjective symptom relief was experienced by 76% and reported more often by patients with external rectal prolapse than with internal rectal prolapse (86% vs 68%; p < 0.001). Complications occurred in 11.4% of patients, and the recurrence rate for rectal prolapse was 7.1%.

LIMITATIONS: This study was limited by its lack of preoperative functional data and suboptimal questionnaire response rate.

CONCLUSIONS: Ventral mesh rectopexy effectively treats posterior pelvic floor dysfunction with a low complication rate and an acceptable recurrence rate. Patients with external rectal prolapse benefit more from the operation than those with symptomatic internal rectal prolapse. See Video Abstract at http://links.lww.com/DCR/A479.

1 Division of Gastroenterology, Department of Surgery, Oulu University Hospital, Oulu, Finland

2 Centre of Surgical Research, Medical Research Centre, University of Oulu, Oulu, Finland

3 Department of Surgery, Keski-Suomi Central Hospital, Jyväskylä, Finland

4 Department of Surgery, Helsinki University Hospital, Helsinki, Finland

5 Department of Surgery, Päijät-Häme Central Hospital, Lahti, Finland

6 Department of Surgery, University of Turku, Turku, Finland

Funding/Support: This study received state funding provided to Oulu University, Finland.

Financial Disclosure: None reported.

Part of the results were presented at the national meeting of the Finnish Society of Surgery, Helsinki, Finland, November 16, 2016.

Correspondence: Johanna Mäkelä-Kaikkonen, M.D., Division of Gastroenterological Surgery, Department of Surgery, Oulu University Hospital, PL 21, 90029 OYS Oulu, Finland. E-mail: johanna.makela-kaikkonen@ppshp.fi

© 2018 The American Society of Colon and Rectal Surgeons