LAPAROSCOPIC-ASSISTED RESECTION-RECTOPEXY FOR RECTAL PROLAPSE - EARLYAND MEDIUM FOLLOW-UP

PURPOSE: Objectives of this study were to describe the technique of la paroscopic-assisted resection rectopexy and audit the clinical outcome s, including review of functional results, METHODS: Data were prospect ively collected for duration of operation, time to passage of flatus a nd feces postoperatively, hospital stay, morbidity, and mortality. Fol low-up was performed by an independent assessor using a standardized q uestionnaire. Patients were also assessed by clinical review or teleph one interview. RESULTS: During a four-year period, 34 patients underwe nt laparoscopic repair for rectal prolapse, of which 30 patients under went laparoscopic-assisted resection rectopexy. Median duration of the operations was 185 minutes, median time for passage of flatus was mio days postoperatively, and median length of hospital stay was five day s. Morbidity was 13 percent and mortality rate was 3 percent. Comparis on between the first ten patients who underwent laparoscopic-assisted resection rectopexy and the last ten revealed a significant reduction in both median duration of operating time (224 vs. 163 minutes: P < 0. 005) and length of stay (6 vs. 4 days; P < 0.015). Follow-up study con ducted at a median time of 18 months revealed that most patients (92 p ercent) felt that the operation had improved their symptoms, that inco ntinence was improved in 14 of 20 patients with impaired continence (7 0 percent), and that constipation was improved in 64 percent. Symptoms of incomplete emptying and the need to strain at stool were both impr oved in 62 and 59 percent of patients, respectively. No full-thickness recurrences have occurred, but two patients have had mucosal prolapse detected (7 percent) and treated. CONCLUSION: Laparoscopic-assisted r esection rectopexy is feasible and safe, with acceptable recurrence ra tes and functional results compared with the open procedure in the sur gical literature. There is rapid return of intestinal function associa ted with an early discharge from hospital.