Comparison of laparoscopic rectopexy with open technique in the treatment of complete rectal prolapse - Clinical and functional results

The aim of this retrospective study was to compare the functional and clini cal results of laparoscopic rectopexy with those of the open technique in t wo similar groups of patients with complete rectal prolapse and fecal incon tinence. Between November 1992 and June 1997, 21 patients underwent abdomin al rectopexy. Thirteen patients (group A: 12 women and I man, mean age 52.9 years, range 28-70) and 8 patients (group B: 8 women, mean age 58.2 years, range 20-76) were submitted to Well's rectopexy by the open technique and the laparoscopic approach, respectively, without division of the lateral re ctal ligaments. Assignment to each group was done randomly. Before the oper ation, a detailed clinical history was taken, and patients were studied wit h inspection and digital examination of the anorectum, proctosigmoidoscopy, determination of pancolonic transit time, dynamic defecography, anorectal manometry, and anal electromyography. After the operation, all patients und erwent perineal physiotherapy, external electric stimulation, and perineal biofeedback. The mean follow-up time was 29.5 months (range 6-54) in group A and 25.7 months (range 8-45) in group B. Values were compared by chi-squa re, Mann-Whitney U, and Wilcoxon tests, as appropriate; differences were co nsidered significant at p < 0.05. In both groups, dyschezia and fecal incon tinence improved significantly (p < 0.05) after the operation. Basal pressu re of anal sphincter, squeezing pressure, and rectoanal reflex improved wit hout significance, whereas anoperineal pain was not significantly reduced. In group B, the postoperative hospital stay was shorter than in group A, wi th a marked reduction of costs. Laparoscopic Well's rectopexy has the same clinical and functional results as the open technique, with a shorter posto perative hospital stay and lower costs.