Laparoscopic surgery for rectal prolapse and outlet obstruction

PURPOSE: The aim of this study was to assess the outcome of both laparoscop ic suture rectopexy and resection-rectopexy in the treatment of complete an d incomplete rectal prolapse, outlet obstruction, or both. METHODS: Data fr om surgery were collected prospectively. Semiannual follow-up was performed by assessment of recurrence, continence, and constipation using patients' history, physical examination, continence score, and anorectal manometry. S tatistical analysis was performed by chi-squared test and Student's t-test (P < 0.05 was accepted as statistically significant). RESULTS: Between Sept ember 1992 and February 1997, 72 patients (68 females) with a mean age of 6 2 (range, 23-88) years were treated laparoscopically. Indications for surge ry were rectal prolapse in 21 patients, rectal prolapse combined with outle t obstruction in 36 patients, and outlet obstruction alone in 15 patients. Standard procedure was a laparoscopic suture rectopexy. A sigmoid resection was added in 40 patients. Mean duration of surgery was 227 (range, 125-360 ) minutes for rectopexy and 258 (range, 150-380) minutes for resection-rect opexy. Conversion was necessary in 1.4 percent (n = 1). Overall complicatio n rate was 9.7 percent (n = 7) and mortality rate was 0 percent. Mean posto perative hospitalization was 15 (range, 6-47) days. All patients with a min imal follow-up of two years (n = 53) could be enrolled in a prospective fol low-up study (mean follow-rip, 30 months). No recurrence of rectal prolapse had to be recognized. Sixty-four percent of patients with incontinence bef ore surgery were continent or had improved continence. In patients experien cing constipation preoperatively, constipation was improved or completely r emoved in 76 percent. No additional symptoms of constipation occurred after surgery. CONCLUSION: Laparoscopic procedures in the treatment of pelvic fl oor disorders, e.g., rectal prolapse or outlet obstruction, lead to accepta ble functional results. However, follow-up has to be extended and long-term results of recurrence, continence, and constipation have to be evaluated.