LAPAROSCOPIC RECTOPEXY USING MESH FIXATION WITH A SPIKED CHROMIUM STAPLE

Abdominal rectopexy for patients with rectal prolapse is well suited f or performance laparoscopically because no resection or anastomosis is necessary, with potential benefits being a decrease in postoperative pain, better cosmesis, and an earlier return to normal activity. PURPO SE: Objectives of this study were to determine the feasibility of lapa roscopic abdominal rectopexy using a solitary spiked chromium staple t o fix the mesh to the sacrum and to compare initial results with conse cutive previous abdominal rectopexies (historical control study). METH ODS: Duration of operation (anesthetic plus surgery), the day a solid diet was first tolerated, day of discharge, and patient morphine requi rements in the first 48 hours were documented prospectively for the la paroscopic group and retrospectively from medical records for an open abdominal rectopexy group. RESULTS: Laparoscopic rectopexy group had l ower morphine requirements when using patient-controlled analgesia (me an, 38.2 vs. 100.6 mg; P < 0.02), an earlier tolerance of solid diet ( mean, 2.7 vs. 5.8 days; P < 0.001), and an earlier discharge from the hospital (mean, 6.3 vs. 11.0 days; P < 0.01). Operating time was longe r for the laparoscopic group (mean, 198 vs. 130 minutes; P < 0.001). C ONCLUSIONS: Laparoscopic rectopexy is feasible, may have benefits in r educing postoperative pain, and may aid earlier return to normal diet and activity. Given the inherent bias of a historical control study, a randomized controlled study has commenced to confirm these results.