Laparoscopic repair of rectal prolapse - A prospective study evaluating surgical outcome and changes in symptoms and bowel function

Background: There have been few large series that have focused on the feasi bility of the laparoscopic approach for rectal prolapse. This single-instit ution study prospectively examines the surgical outcome and changes in symp toms and bowel function following the laparoscopic repair of rectal prolaps e. Methods: In a selected group of 34 patients (total prolapse, 28: intussusce ption, six), 17 patients underwent laparoscopic-assisted resection rectopex y and 17 patients received a laparoscopic sutured rectopexy. Preoperative a nd postoperative evaluation at 3, 6, and 12 months included assessment of t he severity of anal incontinence, constipation, changes in constipation-rel ated symptoms, and colonic transit time. Results: Median operation time was 255 min (range, 180-360) in the resectio n rectopexy group and 150 min (range, 90-295) in the rectopexy alone group. Median postoperative hospital stay was 5 days (range, 3-15) and median tim e off work was 14 days (range, 12-21) in both groups. There were no deaths. Postoperative morbidity was 24%. Incontinence improved significantly regar dless of which method was used. The main determinant of constipation was ex cessive straining at defecation. Constipation was cured in 70% of the patie nts in the rectopexy group and 64% in the resection rectopexy group. Sympto ms of difficult evacuation improved, but the changes were significant only after resection rectopexy. Two patients (7%) developed recurrent total prol apse during a median follow-up of 2 years (range 12-60 months). Conclusions: Laparoscopic-sutured rectopexy and laparoscopic-assisted resec tion rectopexy are feasible and carry an acceptable morbidity rate. They el iminate prolapse and cure incontinence in the great majority of patients. C onstipation and symptoms of difficult evacuation are alleviated.