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Perry WRG, Christensen P, Collinson RJ, Cornish JA, D’Hoore A, Gurland BH, Mellgren A, Ratto C, Ris F, Stevenson ARL, Bordeianou L. Ventral Rectopexy: An International Expert Panel Consensus and Review of Contemporary Literature. Dis Colon Rectum 2025; 68:593-607. [PMID: 39882786 PMCID: PMC11999100 DOI: 10.1097/dcr.0000000000003656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2025]
Abstract
BACKGROUND Ventral rectopexy has become increasingly used in the surgical management of rectal prolapse. There is a need for a contemporary evaluation of the role of the procedure and a description of its use in clinical practice. OBJECTIVE To create an international consensus on ventral rectopexy. DESIGN An expert panel undertook a scoping review of the literature to identify subject domains of interest. Literature reviews were completed for each domain with subsequent development of evidence-based and practice-based statements. These statements were compiled and reviewed by the group over a total of 9 meetings. Once statements were confirmed, supportive text was finalized, and an anonymous vote was completed using Research Electronic Data Capture to record consensus. SETTING An international expert panel comprising colorectal surgeons who perform ventral rectopexy in a high-volume center. MAIN OUTCOME MEASURES Statements and associated expert consensus. RESULTS Eleven experts identified 10 domains for review: indications, contraindications, assessment and planning, consent, operative details, prostheses, complications, follow-up, recurrence and reoperative surgery, and specific considerations. After round table review, there were 17 resultant statements for consideration. Experts agreed unanimously with 13 of the statements and their accompanying text, with different experts disagreeing regarding the remaining 4 statements (91% consensus each). LIMITATIONS Paucity of high-quality data. CONCLUSIONS This international group developed 17 statements with high consensus. These statements provide an up-to-date summary of the literature, identify key areas for research development, and provide a reference point for colon and rectal surgeons who undertake ventral rectopexy as part of their practice. See Video Abstract . RECTOPEXIA VENTRAL CONSENSO DE UN PANEL INTERNACIONAL DE EXPERTOS Y REVISIN DE LA LITERATURA CONTEMPORNEA ANTECEDENTES:La rectopexia ventral se ha utilizado cada vez más en el tratamiento quirúrgico del prolapso rectal. Es necesario realizar una evaluación contemporánea del rol del procedimiento y una descripción de su uso en la práctica clínica.OBJETIVO:Crear un consenso internacional sobre la rectopexia ventral.DISEÑO:Un panel de expertos realizó una revisión exhaustiva de la literatura para identificar los dominios temáticos de interés. Se completaron revisiones de la literatura para cada dominio con el desarrollo de declaraciones basadas en la evidencia y la práctica. Estas fueron compiladas y revisadas por el grupo a lo largo de un total de nueve reuniones. Una vez que se confirmaron las declaraciones, se finalizó el texto de apoyo y se completó una votación anónima utilizando REDCap para registrar el consenso.ESCENARIO:Un panel internacional de expertos compuesto por cirujanos colorrectales que realizan rectopexia ventral en un centro de alto volumen.PRINCIPALES MEDIDAS DE RESULTADOS:Declaraciones y consenso de expertos asociado.RESULTADOS:Once expertos identificaron diez dominios a revisar: indicaciones, contraindicaciones, evaluación y planificación, consentimiento, detalles operatorios, prótesis, complicaciones, seguimiento, recurrencia y cirugía reoperatoria y consideraciones específicas. Después de la revisión en mesa redonda, hubo 17 declaraciones resultantes para su consideración. Los expertos estuvieron de acuerdo unánimemente con trece de las declaraciones y su texto acompañante, y diferentes expertos estuvieron en desacuerdo con cuatro declaraciones (91% de consenso cada una).LIMITACIONES:Escasez de datos de alta calidad.CONCLUSIÓN:Este grupo internacional desarrolló 17 declaraciones con alto consenso. Estas declaraciones proporcionan un resumen actualizado de la literatura, identifican áreas claves para el desarrollo de la investigación y un punto de referencia para los cirujanos de colon y recto que realizan rectopexia ventral como parte de su práctica. (Traducción-Dr. Aurian Garcia Gonzalez ).
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Affiliation(s)
| | - Peter Christensen
- Department of Surgical Gastroenterology, Aarhus University, Aarhus, Denmark
| | - Rowan J. Collinson
- Colorectal Unit, Department of General Surgery, Te Toka Tumei Auckland City Hospital, Auckland, New Zealand
| | - Julie A. Cornish
- Cardiff and Vale University Health Board, Cardiff, United Kingdom
| | - André D’Hoore
- Department of Abdominal Surgery, UZ Leuven, Leuven, Belgium
| | - Brooke H. Gurland
- Division of General Surgery, Stanford Medicine, Palo Alto, California
| | - Anders Mellgren
- Department of Surgical Oncology, King Faisal Specialist Hospital, Research Center, Riyadh, Saudi Arabia
| | - Carlo Ratto
- Proctology and Pelvic Floor Surgery Unit, Catholic University, Ospedale Isola Tiberina-Gemelli Isola, Rome, Italy
| | - Frederic Ris
- Division of Digestive Surgery, Hôpitaux Universitaires Genève, Geneva, Switzerland
| | | | - Liliana Bordeianou
- Colorectal Surgery Section, Department of Surgery, Center for Pelvic Floor Disorders, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Van den Broeck S, Jacquemyn Y, Hubens G, De Schepper H, Vermandel A, Komen N. Rectocele: victim of availability bias? Results of a Belgian survey of colorectal and gynecological surgeons. Int Urogynecol J 2022; 33:3505-3517. [PMID: 35201369 DOI: 10.1007/s00192-022-05118-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 02/01/2022] [Indexed: 10/19/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Women with a symptomatic rectocele may undergo different trajectories depending on the specialty consulted. This survey aims to evaluate potential differences between colorectal surgeons and gynecologists concerning the management of a rectocele. METHODS A web-based survey was sent to abdominal surgeons (CS group) and gynecologists (G group) asking about their perceived definition, diagnostic workup, multidisciplinary discussion (MDT) and surgical treatment of rectoceles. The answers of both groups were analyzed with the chi-square test or Fisher's exact test at p < 0.050. RESULTS A rectocele was defined as a prolapse of the posterior vaginal wall by 78% of the G and 41% of the CS group. All gynecologists and 49% of the CS group evaluated a rectocele clinically in dorsal decubitus, with 91% of gynecologists using a speculum and 65% using the Pelvic Organ Prolapse-Quantification (POP-Q) scoring system, compared to < 1/3 of colorectal surgeons. A digital rectal examination was performed by 90% of the CS group and 57% of the G group. A transvaginal ultrasound was only used by the G group, while anal manometry was opted for by the CS group (65%) and minimally by the G group (14%). In the G group, a posterior repair was the preferred surgical technique (78%), whereas 63% of the CS group preferred a rectopexy. Multidisciplinary discussions (MDT) were mostly organized ad hoc. CONCLUSIONS An availability bias is seen in different aspects of rectocele evaluation and treatment. Colorectal surgeons and gynecologists are acting based on their training and experience. Motivation for pelvic floor MDT starts with creating awareness of the availability bias.
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Affiliation(s)
- Sylvie Van den Broeck
- Department of Abdominal, Pediatric and Reconstructive Surgery, Antwerp University Hospital, Drie Eikenstraat 566, 2650, Edegem, Belgium. .,Antwerp ReSURG, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, University of Antwerp, 2610, Antwerp, Belgium.
| | - Yves Jacquemyn
- Antwerp ReSURG, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, University of Antwerp, 2610, Antwerp, Belgium.,Department of Obstetrics and Gynaecology, Antwerp University Hospital, 2650, Edegem, Belgium.,Global Health Institute (GHI), Faculty of Medicine and Health Sciences, University of Antwerp, 2610, Edegem, Antwerp, Belgium
| | - Guy Hubens
- Department of Abdominal, Pediatric and Reconstructive Surgery, Antwerp University Hospital, Drie Eikenstraat 566, 2650, Edegem, Belgium.,Antwerp ReSURG, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, University of Antwerp, 2610, Antwerp, Belgium
| | - Heiko De Schepper
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, 2650, Edegem, Belgium
| | - Alexandra Vermandel
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, 2610, Antwerp, Belgium
| | - Niels Komen
- Department of Abdominal, Pediatric and Reconstructive Surgery, Antwerp University Hospital, Drie Eikenstraat 566, 2650, Edegem, Belgium.,Antwerp ReSURG, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, University of Antwerp, 2610, Antwerp, Belgium
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Olatunbode O, Rangarajan S, Russell V, Viswanath YKS, Reddy A. A quantitative study to explore functional outcomes following laparoscopic ventral mesh rectopexy for rectal prolapse. Ann R Coll Surg Engl 2022; 104:449-455. [PMID: 34939835 PMCID: PMC9158073 DOI: 10.1308/rcsann.2021.0212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Rectal prolapse is a life-altering problem and laparoscopic ventral mesh rectopexy (LVMR) is emerging as the surgical intervention of choice. However, the literature is ambiguous on its effect on bowel function and sparse as regards bladder and sexual function. This study assesses short-term functional outcomes following LVMR. MATERIALS AND METHODS This quantitative retrospective study with a pretest-post-test design included 130 adults who had undergone LVMR from October 2010 to December 2018 in a tertiary centre. Analysis with paired-samples t-test and Wilcoxon matched pairs test was done using SPSS (v26). RESULTS The median age was 58 years (interquartile range, 48-74 years); 123 (94.6%) were female. The median length of stay was two days (interquartile range, 1-2 days). A total of 104 (80%) sets of medical notes were reviewed. One patient had recurrence of rectal prolapse. Synthetic mesh was used in 24 patients (23.1%) and biological mesh in 80 (76.9%). One patient had extrusion of a synthetic mesh and required surgery; 31(23.8%) completed the Electronic Patient Assessment Questionnaire for Pelvic Floor. Overall, the improvement in bladder function was not statistically significant (p = 0.670). A statistically significant improvement was seen for all bowel symptoms (p = 0.002) excluding constipation (p = 0.295). Irritable bowel symptoms associated with rectal prolapse improved significantly following LVMR (p = 0.001). Vaginal prolapse (p < 0.0005), dyspareunia (p = 0.001) and bowel symptoms affecting sexual intercourse (p = 0.01) improved, but improvement in overall sexual function was not statistically significant (p = 0.081). CONCLUSIONS LVMR improves bowel function overall, although it can worsen constipation. It has the potential to improve sexual function but makes negligible difference to bladder function.
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Affiliation(s)
- O Olatunbode
- James Cook University Hospital, Middlesbrough, UK
| | - S Rangarajan
- James Cook University Hospital, Middlesbrough, UK
| | - V Russell
- School of Health and Social Care, Teesside University, Middlesbrough, UK
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Grossi U, Lacy-Colson J, Brown SR, Cross S, Eldridge S, Jordan M, Mason J, Norton C, Scott SM, Stevens N, Taheri S, Knowles CH. Stepped-wedge randomized controlled trial of laparoscopic ventral mesh rectopexy in adults with chronic constipation. Tech Coloproctol 2022; 26:941-952. [PMID: 35588336 PMCID: PMC9117980 DOI: 10.1007/s10151-022-02633-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/01/2022] [Indexed: 12/13/2022]
Abstract
Background The effectiveness of laparoscopic ventral mesh rectopexy (LVMR) in patients with defecatory disorders secondary to internal rectal prolapse is poorly evidenced. A UK-based multicenter randomized controlled trial was designed to determine the clinical efficacy of LVMR compared to controls at medium-term follow-up. Methods The randomized controlled trial was conducted from March 1, 2015 TO January 31, 2019. A stepped-wedge RCT design permitted observer-masked data comparisons between patients awaiting LVMR (controls) with those who had undergone surgery. Adult participants with radiologically confirmed IRP refractory to conservative treatment were randomized to three arms with different delays before surgery. Efficacy outcome data were collected at equally stepped time points (12, 24, 36, 48, 60, and 72 weeks). Clinical efficacy of LVMR compared to controls was defined as ≥ 1.0-point reduction in Patient Assessment of Constipation-Quality of Life and/or Symptoms (PAC-QOL and/or PAC-SYM) scores at 24 weeks. Secondary outcome measures included 14-day diary data, the Generalized Anxiety Disorder scale (GAD-7), the Patient Health Questionnaire-9 (PHQ-9), St Marks incontinence score, the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12), the chronic constipation Behavioral Response to Illness Questionnaire (CC-BRQ), and the Brief Illness Perception Questionnaire (BIPQ). Results Of a calculated sample size of 114, only 28 patients (100% female) were randomized from 6 institutions (due mainly to national pause on mesh-related surgery). Nine were assigned to the T0 arm, 10 to T12, and 9 to T24. There were no substantial differences in baseline characteristics between the three arms. Compared to baseline, significant reduction (improvement) in PAC-QOL and PAC-SYM scores were observed at 24 weeks post-surgery (– 1.09 [95% CI – 1.76, – 0.41], p = 0.0019, and – 0.92 [– 1.52, – 0.32], p = 0.0029, respectively) in the 19 patients available for analysis (9 were excluded for dropout [n = 2] or missing primary outcome [n = 7]). There was a clinically significant long-term reduction in PAC-QOL scores (− 1.38 [− 2.94, 0.19], p = 0.0840 at 72 weeks). Statistically significant improvements in PAC-SYM scores persisted to 72 weeks (− 1.51 [− 2.87, − 0.16], p = 0.0289). Compared to baseline, no differences were found in secondary outcomes, except for significant improvements at 24 and 48 weeks on CC-BRQ avoidance behavior (− 14.3 [95% CI − 23.3, − 5.4], and − 0.92 [− 1.52, − 0.32], respectively), CC-BRQ safety behavior (− 13.7 [95% CI − 20.5, − 7.0], and − 13.0 [− 19.8, − 6.1], respectively), and BIPQ negative perceptions (− 16.3 [95% CI − 23.5, − 9.0], and − 10.5 [− 17.9, − 3.2], respectively). Conclusions With the caveat of under-powering due to poor recruitment, the study presents the first randomized trial evidence of short-term benefit of LVMR for internal rectal prolapse. Trial registration ISRCTN Registry (ISRCTN11747152). Supplementary Information The online version contains supplementary material available at 10.1007/s10151-022-02633-w.
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Affiliation(s)
- U Grossi
- Centre for Neuroscience, Surgery and Trauma, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
- Department of Surgery, Oncology and Gastroenterology, DISCOG, University of Padua, Padua, Italy.
| | - J Lacy-Colson
- Royal Shrewsbury Hospital, Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, UK
| | - S R Brown
- Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - S Cross
- Pragmatic Clinical Trials Unit, Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - S Eldridge
- Pragmatic Clinical Trials Unit, Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - M Jordan
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - J Mason
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - C Norton
- Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - S M Scott
- Centre for Neuroscience, Surgery and Trauma, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - N Stevens
- Centre for Neuroscience, Surgery and Trauma, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - S Taheri
- Centre for Neuroscience, Surgery and Trauma, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - C H Knowles
- Centre for Neuroscience, Surgery and Trauma, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Ventral Prosthesis Rectopexy for obstructed defaecation syndrome: a systematic review and meta-analysis. Updates Surg 2021; 74:11-21. [PMID: 34665411 DOI: 10.1007/s13304-021-01177-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 09/19/2021] [Indexed: 10/20/2022]
Abstract
Obstructed Defecation Syndrome (ODS) is a rather complex entity concerning mainly females and causing primarily constipation. Surgical treatment in the form of Ventral Prosthesis Rectopexy (VPR) has been proposed and seems to have the best outcomes. However, the selection criteria of patients to undergo this kind of operation are not clear and the reported outcomes are mainly short-term and data on long-term outcomes is scarce. This study assesses new evidence on the efficacy of VPR for the treatment of ODS, specifically focusing on inclusion criteria for surgery and the long-term outcomes. A search was performed of MEDLINE, EMBASE, Ovid and Cochrane databases on all studies reporting on VPR for ODS from 2000 to March 2020. No language restrictions were made. All studies on VPR were reviewed systematically. The main outcomes were intra-operative complications, conversion, procedure duration, short-term mortality and morbidity, length of stay, faecal incontinence and constipation, quality of life (QoL) score and patient satisfaction. Quality assessment and data extraction were performed independently by three observers. Fourteen studies including 963 patients were eligible for analysis. The immediate postoperative morbidity rate was 8.9%. A significant improvement in constipation symptoms was observed in the 12-month postoperative period for ODS (p < 0.0001). Current evidence shows that VPR offers symptomatic relief to the majority of patients with ODS, improving both constipation-like symptoms and faecal incontinence for at least 1-2 years postoperatively. Some studies report on functional results after longer follow-up, showing sustainable improvement, although in a lesser extent.
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Functional and sexual outcome of laparoscopic ventral mesh rectopexy vs transperineal mesh repair in the treatment of rectocele: a retrospective analysis. Eur Surg 2021. [DOI: 10.1007/s10353-021-00695-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Zawodnik A, Balaphas A, Buchs NC, Zufferey G, Robert-Yap J, Buhler LH, Roche B, Ris F. Does Surgical Approach in Pelvic Floor Repair Impact Sexual Function in Women? Sex Med 2019; 7:522-529. [PMID: 31521573 PMCID: PMC6963122 DOI: 10.1016/j.esxm.2019.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 08/06/2019] [Accepted: 08/12/2019] [Indexed: 02/07/2023] Open
Abstract
Introduction Surgical routes used to correct complex pelvic floor disorders (CPFDs) may have a negative impact on women’s sexual function. Currently, there is no evidence concerning the impact of a specific surgical procedure on postoperative sexual function in women. Aim The aim of this study was to compare an abdominal approach with rectopexy and sacrocolpopexy to a perineal procedure with abdominal rectopexy, regarding female sexual function in cases of CPFDs. Methods Women who were operated for CPFDs between January 2003 and June 2010 were retrospectively asked to answer the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12, the Miller Score of Incontinence, and a urinary incontinence frequency score. We also questioned them about their sexual function and satisfaction before and after the operation using visual analogic scores. Main Outcome Measure We compared the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12 before and after the surgery in both groups, and we made an intragroup comparison. Results There were 334 women identified, but only 51 could be included. Globally, we found no statistically significant differences in terms of sexual function before and after surgery between the 25 groups. Intragroup comparison demonstrated that, within the perineal approach group, patients experienced a decrease in their sexual arousal after the procedure. The choice of surgical route for pelvic floor disorders does not seem to have an impact on the results of postoperative sexual function in women. This study adds to the limited literature on sexual outcomes of surgery for CPFD. It is limited principally due to its retrospective design and the small number of patients included. Conclusion Both surgical routes have very similar outcomes on most sexual questions. A perineal approach combined with abdominal rectopexy did, however, demonstrate a slight decrease in sexual arousal of the patients after the intervention. Zawodnik A, Balaphas A, Buchs NC, et al. Does Surgical Approach in Pelvic Floor Repair Impact Sexual Function in Women? Sex Med 2019;7:522–529.
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Affiliation(s)
- Astrid Zawodnik
- Department of Visceral Surgery, Geneva University Hospitals (HUG) and Medical School, Geneva, Switzerland.
| | - Alexandre Balaphas
- Department of Visceral Surgery, Geneva University Hospitals (HUG) and Medical School, Geneva, Switzerland
| | - Nicolas Christian Buchs
- Department of Visceral Surgery, Geneva University Hospitals (HUG) and Medical School, Geneva, Switzerland
| | - Guillaume Zufferey
- Department of General Surgery, Western Lemanic Hospitals Group (GHOL), Nyon, Switzerland
| | - Joan Robert-Yap
- Department of Visceral Surgery, Geneva University Hospitals (HUG) and Medical School, Geneva, Switzerland; Department of General Surgery, Western Lemanic Hospitals Group (GHOL), Nyon, Switzerland
| | - Leo H Buhler
- Department of Visceral Surgery, Geneva University Hospitals (HUG) and Medical School, Geneva, Switzerland
| | - Bruno Roche
- Department of Visceral Surgery, Geneva University Hospitals (HUG) and Medical School, Geneva, Switzerland
| | - Frédéric Ris
- Department of Visceral Surgery, Geneva University Hospitals (HUG) and Medical School, Geneva, Switzerland
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Gültekin FA. Short term outcome of laparoscopic ventral mesh rectopexy for rectal and complex pelvic organ prolapse: case series. Turk J Surg 2019; 35:91-97. [PMID: 32550312 DOI: 10.5578/turkjsurg.4157] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 04/24/2018] [Indexed: 12/13/2022]
Abstract
Objectives Laparoscopic ventral mesh rectopexy (LVMR) is a technique gaining more recognition for the management of pelvic floor disorders, such as external rectal prolapse (ERP), high grade internal rectal prolapse (IRP) and rectocele. LVMR also allows correction of coexisted pelvic organ prolapse. This study aimed to evaluate the safety, efficacy and functional outcome of LVMR for rectal and complex pelvic organ prolapse. Material and Methods All patients who underwent LVMR from February 2014 to October 2017 were included into the study. The patients were evaluated preoperatively and three months postoperatively. Surgical complications and functional results in terms of fecal incontinence (measured with the Wexner Incontinence Score= WIS) and constipation (measured with the Wexner Constipation Score= WCS) were analyzed. Results Thirty (4 males) patients underwent LVMR. Seventeen (56.6%) patients had complex pelvic organ prolapse according to MRI findings. Median operative time and postoperative stay were 110 minutes and 4 days, respectively. No mesh-related complication and recurrence were observed. Before surgery, 21 (70%) patients had complained about symptoms of obstructed defecation. WCS decreased significantly from median 19 to 6 (p <0.001). Preoperative median WIS of 9 patients was 14 and went down to 6 postoperatively (p= 0.008). WCS significantly improved after LVMR in patients with symptomatic rectocele combined with enterocele or sigmoidocele (p= 0.005), and significant improvement was also observed in patients with symptomatic rectocele combined with gynecologic organ prolapse, preoperative median WCS was 18 and the postoperative value fell to 8 (p= 0.005). Conclusion LVMR is an effective surgical option for rectal and complex pelvic organ prolapse with short-term follow-up.
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Affiliation(s)
- Fatma Ayça Gültekin
- Zonguldak Bülent Ecevit Üniversitesi Tıp Fakültesi, Genel Cerrahi Anabilim Dalı, Zonguldak, Türkiye
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A review of the effect of faecal incontinence and constipation on sexual function. Int J Colorectal Dis 2019; 34:387-391. [PMID: 30635719 DOI: 10.1007/s00384-018-03231-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/27/2018] [Indexed: 02/04/2023]
Abstract
AIM Faecal incontinence and constipation are common conditions which may adversely affect quality of life. They may have an adverse effect on sexual function. METHOD This review of the published literature aimed to assess the published evidence. RESULTS Only seven published studies have reported the effect of these conditions on sexual function. Four reported on those with faecal incontinence. Two reported on those with faecal incontinence and constipation and one reported solely on constipation. All were questionnaire-based studies or retrospective reviews of institutional databases. A heterogenous mix of different measures of sexual function were applied. Conflicting findings were reported. Some studies suggested that those with faecal incontinence and constipation may have adverse sexual experiences. Others suggest that these pelvic floor disorders have no significant effect. CONCLUSION Further work is needed to investigate this. Large questionnaire studies with normal subject controls and adjustment for confounding factors are likely to be needed.
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Ahmad NZ, Stefan S, Adukia V, Naqvi SAH, Khan J. Laparoscopic Ventral Mesh Rectopexy: Functional Outcomes after Surgery. Surg J (N Y) 2018; 4:e205-e211. [PMID: 30377654 PMCID: PMC6205861 DOI: 10.1055/s-0038-1675358] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 09/10/2018] [Indexed: 01/23/2023] Open
Abstract
Aims
Rectal prolapse is a debilitating and unpleasant condition adversely affecting the quality of life. Laparoscopic ventral mesh rectopexy (LVMR) is recognized as one of the treatment options. The aim of this study was to evaluate the functional outcomes after a standardized LVMR.
Methods
A cohort of patients who underwent LVMR from 2011 to 2015 were contacted and asked to fill questionnaires about their symptoms before and after the surgery. Three questionnaires based on measurement of Wexner fecal incontinence (WFI), obstructive defecation syndrome (ODS), and Birmingham Bowel and Urinary Symptom (BBUS) scores were used to assess the changes in postoperative functional outcomes. Some additional questions were also added to further assess bowel dysfunction.
Results
There were 58 female patients with a mean age of 62.74 ± 15.20 (26–86) years in this cohort. About 70% of the patients participated in the study and returned the filled questionnaires. There was a significant overall improvement across all three scores (WFI:
p
= 0.001, ODS:
p
= 0.001, and BBUS:
p
= 0.001). Some individual components in the scoring systems did not improve to patient's satisfaction. No perioperative complication or conversion to an open procedure was reported in this study. Three recurrences were seen in the redo cases.
Conclusion
LVMR is a promising way of dealing with rectal prolapse. A careful patient selection, appropriate preoperative workup, and a meticulous surgical technique undoubtedly transform the postoperative outcomes.
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Affiliation(s)
- Nasir Zaheer Ahmad
- Department of Colorectal Surgery, Queen Alexandra Hospital, Portsmouth, United Kingdom
| | - Samuel Stefan
- Department of Colorectal Surgery, Queen Alexandra Hospital, Portsmouth, United Kingdom
| | - Vidhi Adukia
- Department of Colorectal Surgery, Queen Alexandra Hospital, Portsmouth, United Kingdom
| | | | - Jim Khan
- Department of Colorectal Surgery, Queen Alexandra Hospital, Portsmouth, United Kingdom
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Grossi U, Stevens N, McAlees E, Lacy-Colson J, Brown S, Dixon A, Di Tanna GL, Scott SM, Norton C, Marlin N, Mason J, Knowles CH. Stepped-wedge randomised trial of laparoscopic ventral mesh rectopexy in adults with chronic constipation: study protocol for a randomized controlled trial. Trials 2018; 19:90. [PMID: 29402303 PMCID: PMC5800022 DOI: 10.1186/s13063-018-2456-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 12/30/2017] [Indexed: 02/08/2023] Open
Abstract
Background Laparoscopic ventral mesh rectopexy (LVMR) is an established treatment for external full-thickness rectal prolapse. However, its clinical efficacy in patients with internal prolapse is uncertain due to the lack of high-quality evidence. Methods An individual level, stepped-wedge randomised trial has been designed to allow observer-blinded data comparisons between patients awaiting LVMR with those who have undergone surgery. Adults with symptomatic internal rectal prolapse, unresponsive to prior conservative management, will be eligible to participate. They will be randomised to three arms with different delays before surgery (0, 12 and 24 weeks). Efficacy outcome data will be collected at equally stepped time points (12, 24, 36 and 48 weeks). The primary objective is to determine clinical efficacy of LVMR compared to controls with reduction in the Patient Assessment of Constipation Quality of Life (PAC-QOL) at 24 weeks serving as the primary outcome. Secondary objectives are to determine: (1) the clinical effectiveness of LVMR to 48 weeks to a maximum of 72 weeks; (2) pre-operative determinants of outcome; (3) relevant health economics for LVMR; (4) qualitative evaluation of patient and health professional experience of LVMR and (5) 30-day morbidity and mortality rates. Discussion An individual-level, stepped-wedge, randomised trial serves the purpose of providing an untreated comparison for the active treatment group, while at the same time allowing the waiting-listed participants an opportunity to obtain the intervention at a later date. In keeping with the basic ethical tenets of this design, the average waiting time for LVMR (12 weeks) will be shorter than that for routine services (24 weeks). Trial registration ISRCTN registry, ISRCTN11747152. Registered on 30 September 2015. The trial was prospectively registered (first patient enrolled on 21 March 2016). Electronic supplementary material The online version of this article (10.1186/s13063-018-2456-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ugo Grossi
- National Bowel Research Cente (NBRC) - Digestive Disease, Barts and The London School of Medicine and Dentistry, Queen Mary, University of London, 4 Newark Street, London, E1 2AT, UK.
| | - Natasha Stevens
- Pragmatic Clinical Trials Unit, Blizard Institute, Queen Mary, University of London, London, UK
| | - Eleanor McAlees
- National Bowel Research Cente (NBRC) - Digestive Disease, Barts and The London School of Medicine and Dentistry, Queen Mary, University of London, 4 Newark Street, London, E1 2AT, UK
| | | | | | | | - Gian Luca Di Tanna
- Pragmatic Clinical Trials Unit, Blizard Institute, Queen Mary, University of London, London, UK
| | - S Mark Scott
- National Bowel Research Cente (NBRC) - Digestive Disease, Barts and The London School of Medicine and Dentistry, Queen Mary, University of London, 4 Newark Street, London, E1 2AT, UK
| | | | - Nadine Marlin
- Pragmatic Clinical Trials Unit, Blizard Institute, Queen Mary, University of London, London, UK
| | | | - Charles H Knowles
- National Bowel Research Cente (NBRC) - Digestive Disease, Barts and The London School of Medicine and Dentistry, Queen Mary, University of London, 4 Newark Street, London, E1 2AT, UK
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Robot-Assisted Ventral Mesh Rectopexy for Rectal Prolapse: A 5-Year Experience at a Tertiary Referral Center. Dis Colon Rectum 2017; 60:1215-1223. [PMID: 28991087 DOI: 10.1097/dcr.0000000000000895] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Laparoscopic ventral mesh rectopexy is being increasingly performed internationally to treat rectal prolapse syndromes. Robotic assistance appears advantageous for this procedure, but literature regarding robot-assisted ventral mesh rectopexy is limited. OBJECTIVE The primary objective of this study was to assess the safety and effectiveness of robot-assisted ventral mesh rectopexy in the largest consecutive series of patients to date. DESIGN This study is a retrospective cross-sectional analysis of prospectively collected data. SETTINGS The study was conducted in a tertiary referral center. PATIENTS All of the patients undergoing robot-assisted ventral mesh rectopexy for rectal prolapse syndromes between 2010 and 2015 were evaluated. MAIN OUTCOME MEASURES Preoperative and postoperative (mesh and nonmesh) morbidity and functional outcome were analyzed. The actuarial recurrence rates were calculated using the Kaplan-Meier method. RESULTS A total of 258 patients underwent robot-assisted ventral mesh rectopexy (mean ± SD follow-up = 23.5 ± 21.8 mo; range, 0.2 - 65.1 mo). There were no conversions and only 5 intraoperative complications (1.9%). Mortality (0.4%) and major (1.9%) and minor (<30 d) early morbidity (7.0%) were acceptably low. Only 1 (1.3%) mesh-related complication (asymptomatic vaginal mesh erosion) was observed. A significant improvement in obstructed defecation (78.6%) and fecal incontinence (63.7%) were achieved for patients (both p < 0.0005). At final follow-up, a new onset of fecal incontinence and obstructed defecation was induced or worsened in 3.9% and 0.4%. The actuarial 5-year external rectal prolapse and internal rectal prolapse recurrence rates were 12.9% and 10.4%. LIMITATIONS This was a retrospective study including patients with minimal follow-up. No validated scores were used to assess function. The study was monocentric, and there was no control group. CONCLUSIONS Robot-assisted ventral mesh rectopexy is a safe and effective technique to treat rectal prolapse syndromes, providing an acceptable recurrence rate and good symptomatic relief with minimal morbidity. See Video Abstract at http://links.lww.com/DCR/A427.
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13
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Grossi U, Knowles CH, Mason J, Lacy-Colson J, Brown SR. Surgery for constipation: systematic review and practice recommendations: Results II: Hitching procedures for the rectum (rectal suspension). Colorectal Dis 2017; 19 Suppl 3:37-48. [PMID: 28960927 DOI: 10.1111/codi.13773] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIM To assess the outcomes of rectal suspension procedures (forms of rectopexy) in adults with chronic constipation. METHOD Standardised methods and reporting of benefits and harms were used for all CapaCiTY reviews that closely adhered to PRISMA 2016 guidance. Main conclusions were presented as summary evidence statements with a summative Oxford Centre for Evidence-Based Medicine (2009) level. RESULTS Eighteen articles were identified, providing data on outcomes in 1238 patients. All studies reported only on laparoscopic approaches. Length of procedures ranged between 1.5 to 3.5 h, and length of stay between 4 to 5 days. Data on harms were inconsistently reported and heterogeneous, making estimates of harm tentative and imprecise. Morbidity rates ranged between 5-15%, with mesh complications accounting for 0.5% of patients overall. No mortality was reported after any procedures in a total of 1044 patients. Although inconsistently reported, good or satisfactory outcome occurred in 83% (74-91%) of patients; 86% (20-97%) of patients reported improvements in constipation after laparoscopic ventral mesh rectopexy (LVMR). About 2-7% of patients developed anatomical recurrence. Patient selection was inconsistently documented. As most common indication, high grade rectal intussusception was corrected in 80-100% of cases after robotic or LVMR. Healing of prolapse-associated solitary rectal ulcer syndrome occurred in around 80% of patients after LVMR. CONCLUSION Evidence supporting rectal suspension procedures is currently derived from poor quality studies. Methodologically robust trials are needed to inform future clinical decision making.
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Affiliation(s)
- U Grossi
- National Bowel Research Centre, Blizard Institute, Queen Mary University London, London, UK
| | - C H Knowles
- National Bowel Research Centre, Blizard Institute, Queen Mary University London, London, UK
| | - J Mason
- University of Warwick, Coventry, UK
| | | | - S R Brown
- Sheffield Teaching Hospitals, Sheffield, UK
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- National Institute for Health Research: Chronic Constipation Treatment Pathway, London, UK
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- Affiliate section of the Association of Coloproctology of Great Britain and Ireland, London, UK
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14
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Alloplastisches Material in der Prolapschirurgie. COLOPROCTOLOGY 2017. [DOI: 10.1007/s00053-017-0174-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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15
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Ahmad NZ, Khan JS. Laparoscopic ventral mesh rectopexy - a video vignette. Colorectal Dis 2017; 19:594-595. [PMID: 28419672 DOI: 10.1111/codi.13683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 02/05/2017] [Indexed: 02/08/2023]
Affiliation(s)
- N Z Ahmad
- Department of Colorectal Surgery, Queen Alexandra Hospital, Cosham, Portsmouth, UK
| | - J S Khan
- Department of Colorectal Surgery, Queen Alexandra Hospital, Cosham, Portsmouth, UK
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Abstract
Rectoceles are a very common finding in patients, and symptoms most commonly include pelvic pain, pressure, or difficulty with passing stool. However, there are often other associated pelvic floor disorders that accompany rectoceles, making the clinical significance of it in an individual patient often hard to determine. When evaluating a patient with a rectocele, a thorough history and physical exam must be conducted to help delineate other causes of these symptoms. Treatment consists of addressing other defecatory disorders through various methods, with surgery reserved for select cases in which obstructed defecation is well documented.
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Affiliation(s)
- W Conan Mustain
- Division of Colon and Rectal Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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Borie F, Coste T, Bigourdan JM, Guillon F. Incidence and surgical treatment of synthetic mesh-related infectious complications after laparoscopic ventral rectopexy. Tech Coloproctol 2016; 20:759-765. [PMID: 27699496 DOI: 10.1007/s10151-016-1538-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Accepted: 07/26/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND Prosthetic-related infection and erosion occurring after a laparoscopic ventral rectopexy (LVR) are rare complications, and their importance is often underestimated. The aim of this study was to compare the incidence rate and surgical management of these complications in LVR patients with polyester (PE) or polypropylene (PP) prostheses. METHODS From January 2004 to June 2012, 149 patients underwent LVR with PE and 176 underwent LVR with PP. Surgical management and rate of infectious and erosive prosthesis-related complications, depending on the type of prosthesis, were described and compared. Functional results after complications were assessed. RESULTS Five patients from the PE prosthesis group (3.3 %), compared with two patients from the PP prosthesis group (1.1 %), experienced prosthesis-related infection or erosion (p = 0.16). The rate of erosion alone was 3.3 % in patients with a PE prosthesis, and 0.55 % in patients with a PP prosthesis (p = 0.06). The average time until clinical diagnosis of a prosthesis-related complication was identical for both groups: 31 months (range 3-62 months). All patients underwent surgical removal of the prosthesis: For the five patients from the PE group, complete removal was performed by laparoscopy associated with a transanal procedure. For the two patients in the PP mesh group, laparoscopy was ineffective in removing the mesh which was partially removed through a subsequent transanal procedure. None of the patients had a protective stoma, and in all patients the complication had resolved 12 months after removal. Only one patient had worsening functional symptoms (fecal incontinence) after prosthesis removal. CONCLUSIONS When a prosthesis-related infection or erosion occurs, treatment consists in the surgical removal of the prosthesis by laparoscopy/and/or a transanal procedure. Functional symptoms do not routinely recur after prosthesis removal.
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Affiliation(s)
- F Borie
- Hepatobiliary and Gastrointestinal Surgery, Nîmes University Hospital Center, 30000, Nîmes, France. .,Gastrointestinal Surgery St Eloi University Hospital Center, Montpellier, France.
| | - T Coste
- Gastrointestinal Surgery St Eloi University Hospital Center, Montpellier, France
| | - J M Bigourdan
- Hepatobiliary and Gastrointestinal Surgery, Nîmes University Hospital Center, 30000, Nîmes, France
| | - F Guillon
- Gastrointestinal Surgery St Eloi University Hospital Center, Montpellier, France
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19
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Whealon MD, Moghadamyeghaneh Z, Carmichael JC. Robotic ventral rectopexy. SEMINARS IN COLON AND RECTAL SURGERY 2016. [DOI: 10.1053/j.scrs.2016.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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20
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[Alloplastic material in prolapse surgery : Indications and postoperative outcome of ventral rectopexy]. Chirurg 2016; 88:141-146. [PMID: 27515904 DOI: 10.1007/s00104-016-0264-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND In rectopexy the use of meshes provides stability by mechanical support as well as by the induction of scar formation; however, one of the problems of conventional methods of mesh rectopexy is that many patients postoperatively suffer from functional disorders, such as fecal incontinence and stool evacuation disorders. One reason is the damage of vegetative nerves following dorsal and lateral mobilization of the rectum, which is required for positioning of the mesh. In 2004 D'Hoore and Penninckx first described the method of ventral rectopexy, a new technique of mesh rectopexy which allows preservation of the autonomic nerves. OBJECTIVE Does ventral rectopexy provide advantages regarding functional outcome, complications and recurrence rates? MATERIAL AND METHODS A search was carried out in the databases PubMed and Medline for studies on ventral rectoplexy. Presentation and analysis of the current state of relevant studies relating to ventral rectopexy. RESULTS Ventral rectopexy is characterized by a low complication rate and good functional results in terms of improvement of incontinence, constipation and stool evacuation disorders. The indications for ventral rectopexy are considered in patients with external prolapse of the rectum. Also in a well-selected patient population internal prolapse, rectocele as well as enterocele accompanied by obstructive defecation syndrome represent relative indications for ventral rectopexy. CONCLUSION In order to obtain a valid assessment of the value of this procedure it is crucial to improve the current lack of evidence (level 3) by prospective randomized studies that compare ventral rectopexy with other surgical techniques and nonsurgical treatment options.
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van Iersel JJ, Paulides TJC, Verheijen PM, Lumley JW, Broeders IAMJ, Consten ECJ. Current status of laparoscopic and robotic ventral mesh rectopexy for external and internal rectal prolapse. World J Gastroenterol 2016; 22:4977-4987. [PMID: 27275090 PMCID: PMC4886373 DOI: 10.3748/wjg.v22.i21.4977] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 04/15/2016] [Accepted: 05/04/2016] [Indexed: 02/06/2023] Open
Abstract
External and internal rectal prolapse with their affiliated rectocele and enterocele, are associated with debilitating symptoms such as obstructed defecation, pelvic pain and faecal incontinence. Since perineal procedures are associated with a higher recurrence rate, an abdominal approach is commonly preferred. Despite the description of greater than three hundred different procedures, thus far no clear superiority of one surgical technique has been demonstrated. Ventral mesh rectopexy (VMR) is a relatively new and promising technique to correct rectal prolapse. In contrast to the abdominal procedures of past decades, VMR avoids posterolateral rectal mobilisation and thereby minimizes the risk of postoperative constipation. Because of a perceived acceptable recurrence rate, good functional results and low mesh-related morbidity in the short to medium term, VMR has been popularized in the past decade. Laparoscopic or robotic-assisted VMR is now being progressively performed internationally and several articles and guidelines propose the procedure as the treatment of choice for rectal prolapse. In this article, an outline of the current status of laparoscopic and robotic ventral mesh rectopexy for the treatment of internal and external rectal prolapse is presented.
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22
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Abstract
AIM For the treatment of complex pelvic organ prolapse, many different surgical procedures are described without any comparative studies available. Laparoscopic ventral mesh rectopexy after D'Hoore is one of the methods, which is publicized to treat patients with symptomatic rectocele, enterocele and rectal prolapse. METHOD All patients who received ventral mesh rectopexy since 07/10 for symptomatic rectocele, enterocele and possible rectal prolapse I ° or II ° in terms of a complex pelvic floor disorder were included in this follow-up study. The Wexner score for incontinence was recorded (range 0-20), the constipation score of Herold (r6-30) was evaluated as well as supplementary questions compiled by D'Hoore concerning outlet symptoms (r0-20). In addition, the quality of life (SF-12) was requested. RESULTS Thirty-one women were operated in the period, and 27 were eligible to be included in the present study. Median follow-up was 22 months (2-39). The preoperative Wexner score was in median 8 (0-20), going down to 6 (0-20) without significance (p = 0.735). The constipation score decreased significantly from median 14 (9-21) to 11 (6-25) (p = 0.007). The median score after D'Hoore was preoperatively 8 (4-16) and 4.5 (0-17) postoperatively (p = 0.004). The SF-12 values were preoperatively significantly reduced compared to the normal population; postoperatively, they equalized. CONCLUSION Two years after laparoscopic ventral mesh rectopexy, constipation and quality of life improve significantly in patients with complex pelvic organ prolapse. The grade of incontinence remains essentially the same, but was not the dominant clinical problem in the treated patients of our study. STATEMENT The improvement in constipation and quality of life after laparoscopic ventral mesh rectopexy for obstructive defecation is encouraging. However, the impact on sexual life differs; some patients improve but a relevant number reports a change for the worse.
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Tsunoda A, Takahashi T, Ohta T, Fujii W, Kusanagi H. New-onset rectoanal intussusception may not result in symptomatic improvement after laparoscopic ventral rectopexy for external rectal prolapse. Tech Coloproctol 2015; 20:101-7. [PMID: 26589950 DOI: 10.1007/s10151-015-1395-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 09/15/2015] [Indexed: 01/05/2023]
Abstract
BACKGROUND This study was designed to assess defecatory function in patients who underwent laparoscopic ventral rectopexy (LVR) for external rectal prolapse (ERP). METHODS Thirty-one patients who underwent evacuation proctography 6 months postoperatively were assessed. Preoperative proctography had been performed in 21 patients of these patients. Defecatory function was evaluated using the constipation scoring system (CSS) and fecal incontinence severity index (FISI). RESULTS The findings of postoperative proctography revealed no full-thickness ERP in any patient, although in 10 patients the ERP was replaced by rectoanal intussusception (RAI). Of the 31 patients, 30 presented with fecal incontinence preoperatively. Ten of 30 had new-onset RAI. Six months postoperatively, a reduction of at least 50 % in the FISI score of the patients with new-onset RAI tended to be significantly smaller than in the patients without RAI (6/10 vs. 18/20, p = 0.141). Seventeen patients presented with obstructed defecation preoperatively. Seven of them had new-onset RAI. Six months postoperatively, a reduction of at least 50 % in their CSS score in the patients with new-onset RAI was significantly smaller than in patients without RAI (0/7 vs. 8/10, p = 0.002). CONCLUSIONS Evacuation proctography showed new-onset RAI in some patients with ERP who underwent LVR, which was associated with a lack of symptomatic improvement.
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Affiliation(s)
- A Tsunoda
- Department of Gastroenterological Surgery, Kameda Medical Center, 929 Higashi-cho, Kamogawa City, Chiba, 296-8602, Japan.
| | - T Takahashi
- Department of Gastroenterological Surgery, Kameda Medical Center, 929 Higashi-cho, Kamogawa City, Chiba, 296-8602, Japan
| | - T Ohta
- Department of Gastroenterological Surgery, Kameda Medical Center, 929 Higashi-cho, Kamogawa City, Chiba, 296-8602, Japan
| | - W Fujii
- Department of Gastroenterological Surgery, Kameda Medical Center, 929 Higashi-cho, Kamogawa City, Chiba, 296-8602, Japan
| | - H Kusanagi
- Department of Gastroenterological Surgery, Kameda Medical Center, 929 Higashi-cho, Kamogawa City, Chiba, 296-8602, Japan
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Rickert A, Kienle P. Laparoscopic surgery for rectal prolapse and pelvic floor disorders. World J Gastrointest Endosc 2015; 7:1045-1054. [PMID: 26380050 PMCID: PMC4564831 DOI: 10.4253/wjge.v7.i12.1045] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 06/22/2015] [Accepted: 08/31/2015] [Indexed: 02/05/2023] Open
Abstract
Pelvic floor disorders are different dysfunctions of gynaecological, urinary or anorectal organs, which can present as incontinence, outlet-obstruction and organ prolapse or as a combination of these symptoms. Pelvic floor disorders affect a substantial amount of people, predominantly women. Transabdominal procedures play a major role in the treatment of these disorders. With the development of new techniques established open procedures are now increasingly performed laparoscopically. Operation techniques consist of various rectopexies with suture, staples or meshes eventually combined with sigmoid resection. The different approaches need to be measured by their operative and functional outcome and their recurrence rates. Although these operations are performed frequently a comparison and evaluation of the different methods is difficult, as most of the used outcome measures in the available studies have not been standardised and data from randomised studies comparing these outcome measures directly are lacking. Therefore evidence based guidelines do not exist. Currently the laparoscopic approach with ventral mesh rectopexy or resection rectopexy is the two most commonly used techniques. Observational and retrospective studies show good functional results, a low rate of complications and a low recurrence rate. As high quality evidence is missing, an individualized approach is recommend for every patient considering age, individual health status and the underlying morphological and functional disorders.
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Dimitriou N, Shah V, Stark D, Mathew R, Miller AS, Yeung JMC. Defecating Disorders: A Common Cause of Constipation in Women. WOMENS HEALTH 2015; 11:485-500. [DOI: 10.2217/whe.15.25] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Defecating disorders are a common and complex problem. There are a range of anatomical and functional bowel abnormalities that can lead to this condition. Treatment is difficult and needs a multidisciplinary approach. First line treatment for defecating disorders is conservative. For those that fail conservative treatment, some may respond to surgical therapy but with variable results. The aim of this review is to offer an overview of defecating disorders as well as provide an algorithm on how to diagnose and treat them with the help of a multidisciplinary and multimodal approach.
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Affiliation(s)
- Nikoletta Dimitriou
- 1st Department of Surgery, University of Athens, Medical School, Laiko Hospital, Athens, Greece
| | - Vikas Shah
- Department of Radiology, Leicester Royal Infirmary, Infirmary Square, Leicester, LE1 5WW, UK
| | - Diane Stark
- Pelvic Floor Unit, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, LE1 5WW, UK
| | - Ronnie Mathew
- Pelvic Floor Unit, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, LE1 5WW, UK
| | - Andrew S Miller
- Pelvic Floor Unit, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, LE1 5WW, UK
| | - Justin MC Yeung
- Pelvic Floor Unit, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, LE1 5WW, UK
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Ramage L, Georgiou P, Tekkis P, Tan E. Is robotic ventral mesh rectopexy better than laparoscopy in the treatment of rectal prolapse and obstructed defecation? A meta-analysis. Tech Coloproctol 2015; 19:381-9. [PMID: 26041559 DOI: 10.1007/s10151-015-1320-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 04/24/2015] [Indexed: 12/22/2022]
Abstract
Ventral mesh rectopexy is an approach in the treatment of internal and external rectal prolapse and rectocele. Our aim was to assess whether robotic surgery confers any significant advantages over laparoscopy, and the associated complication rate. Two reviewers performed a literature search using MEDLINE and PubMed databases for studies comparing robotic versus laparoscopic surgery. Five prospective, non-randomised studies were identified and included. A total of 244 patients (101 robotic and 143 laparoscopic) were included in the analysis. Operative time was shorter with laparoscopic surgery, mean weighted difference 27.94 [confidence interval (CI) 19.30-36.57; p < 0.00001]. The conversion rate was not significantly different between groups. There was a trend towards a reduction in length of inpatient stay and early post-operative complications in the robotic group; however, these did not reach statistical significance. Recurrence rates were similar between groups (odds ratio 0.91, CI 0.32-2.63; p = 0.87). Functional results were comparable between groups. Early studies show that robotic ventral rectopexy is a safe option compared to the laparoscopic approach, with overall comparable results. There appeared to be a trend towards a reduction in length of inpatient stay and post-operative complications. These perceived benefits may offset the longer operative times and outlay costs. Larger randomised controlled trials are needed to further evaluate clinical value and cost-effectiveness.
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Affiliation(s)
- L Ramage
- Department of Surgery and Cancer, Imperial College London, Chelsea & Westminster Hospital Campus, London, UK
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Laparoscopic ventral rectopexy for rectoanal intussusception: postoperative evaluation with proctography. Dis Colon Rectum 2015; 58:449-56. [PMID: 25751802 DOI: 10.1097/dcr.0000000000000328] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Laparoscopic ventral rectopexy can relieve symptoms of obstructed defecation and fecal incontinence in patients with rectoanal intussusception. However, pelvic floor imaging after surgery has not been reported. OBJECTIVE This study was designed to assess the outcome of patients who underwent laparoscopic ventral rectopexy for rectoanal intussusception, with special reference to the postoperative findings on evacuation proctography. DESIGN This study was a retrospective analysis of prospectively collected data. SETTING The study was conducted from 2012 to 2013 at the Department of Surgery, Kameda Medical Center, Japan. PATIENTS We included 26 patients with symptomatic rectoanal intussusception. INTERVENTION Laparoscopic ventral rectopexy was performed. MAIN OUTCOME MEASURE Evacuation proctography was performed before and 6 months after the procedure. Defecatory function was evaluated using the Constipation Scoring System and Fecal Incontinence Severity Index. RESULTS Of 26 patients with rectoanal intussusception preoperatively, 22 had symptoms of obstructed defecation and 21 complained of fecal incontinence. Postoperatively, rectoanal intussusception was eliminated in all patients, though 8 developed recto rectal intussusception. There was an overall reduction in both grade 2 rectocele size (median preop 26 mm vs. postop 11 mm; p < 0.0001) and pelvic floor descent (median preop 26 mm vs. postop 20 mm; p < 0.0001). 6 months after surgery, a reduction of at least 50% was observed in the Constipation Scoring System score for 9 patients (41%) with obstructive defecation and in the Fecal Incontinence Severity Index score for 14 incontinent patients (67%). LIMITATIONS This was a preliminary study with a small sample size, no control group, and short follow-up time. CONCLUSION Evacuation proctography showed anatomical correction in patients with rectoanal intussusception who underwent laparoscopic ventral rectopexy. However, the data also indicate that such correction does not necessarily result in meaningful symptomatic relief.
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Gouvas N, Georgiou PA, Agalianos C, Tan E, Tekkis P, Dervenis C, Xynos E. Ventral colporectopexy for overt rectal prolapse and obstructed defaecation syndrome: a systematic review. Colorectal Dis 2015; 17:O34-46. [PMID: 25186920 DOI: 10.1111/codi.12751] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 06/18/2014] [Indexed: 12/12/2022]
Abstract
AIM Laparoscopic ventral rectopexy (VR) with the use of prosthesis has been advocated for both overt rectal prolapse (ORP) and obstructed defaecation syndrome (ODS). The present study reviews the short-term and functional results of laparoscopic VR. METHOD A search was performed of MEDLINE, EMBASE, Ovid and Cochrane databases on all studies reporting on VR for ORP, ODS and other anatomical abnormalities of the pelvic floor from 2004 until February 2013. No language restrictions were made. All studies on VR were reviewed systematically. The main outcomes were intra-operative complications, conversion, procedure duration, short-term mortality and morbidity, length of stay, recurrence of ORP, recurrence of anatomical disorder, faecal incontinence and constipation, quality of life (QoL) score and patient satisfaction. Quality assessment and data extraction were performed independently by three observers. RESULTS Twenty-three studies including 1460 patients were eligible for analysis. The conversion rate ranged from 0 to 14.3%. No mortality was reported. The immediate postoperative morbidity rate was 8.6%. Length of stay ranged from 1 to 7 days. A significant improvement in constipation and incontinence symptoms was observed in the postoperative period for both ORP and ODS (chi-square test, P < 0.0001). CONCLUSION Laparoscopic VR is a safe and effective procedure for ORP and ODS. Longer follow-up is required, and studies comparing VR with standard rectopexy and stapled transanal rectal resection are not yet available.
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Affiliation(s)
- N Gouvas
- The 1st Department of General Surgery, Colorectal Unit, 'Konstandopouleion' Hospital of Athens, Athens, Greece
| | - P A Georgiou
- The Department of Surgery and Cancer, Imperial College, Chelsea and Westminster Campus, London, UK
| | - C Agalianos
- The 2nd Department of General Surgery, Athens Naval and Veterans Hospital, Athens, Greece
| | - E Tan
- The Department of Surgery and Cancer, Imperial College, Chelsea and Westminster Campus, London, UK
| | - P Tekkis
- The Department of Surgery and Cancer, Imperial College, Chelsea and Westminster Campus, London, UK
| | - C Dervenis
- The 1st Department of General Surgery, Colorectal Unit, 'Konstandopouleion' Hospital of Athens, Athens, Greece
| | - E Xynos
- The 1st Department of General Surgery, Colorectal Unit, 'Konstandopouleion' Hospital of Athens, Athens, Greece
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Ogilvie JW, Stevenson ARL, Powar M. Case-matched series of a non-cross-linked biologic versus non-absorbable mesh in laparoscopic ventral rectopexy. Int J Colorectal Dis 2014; 29:1477-83. [PMID: 25310924 DOI: 10.1007/s00384-014-2016-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/16/2014] [Indexed: 02/07/2023]
Abstract
PURPOSE Laparoscopic ventral mesh rectopexy (LVR) is an emerging technique for selected patients with rectal prolapse and obstructed defaecation syndrome. Data are insufficient to conclude which type of mesh affords the greatest benefit. Our aim was to compare the outcomes of LVR using a non-cross-linked biologic versus a permanent mesh. METHODS Twenty nine cases of LVR with permanent mesh were matched based on age and surgical indication with an equal number of patients using biologic mesh. Cases were retrospectively reviewed from a prospectively maintained database. Symptom resolution, patient satisfaction and recurrence of prolapse were measured among those who underwent LVR with either a biologic (Biodesign(®), Cook Medical) or polypropylene mesh. RESULTS Age, American Society of Anesthesiologists (ASA) class, surgical indication and primary symptoms were not different between the two groups. After a median follow-up of 15.4 months, all patients reported being either completely or partially satisfied. Rates of complete or partial symptom resolution (p = 0.26) or satisfaction (p = 0.27) did not differ between groups. After LVR, similar rates of additional procedures were performed in the biologic (21 %) and the permanent (28 %) mesh group. Among patients with full-thickness prolapse (n = 33), there were five cases (15 %) of recurrence, one in the biologic group and four in the permanent mesh group (p = 0.37). There were no mesh-related complications in either group. CONCLUSIONS LVR using a non-cross-linked biologic mesh appears to have comparable rates of symptom improvement and patient satisfaction in the short term. Longer follow-up will be required to determine if prolapse recurrence depends on mesh type.
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Affiliation(s)
- James W Ogilvie
- Ferguson Clinic/Spectrum Health, Division of Colorectal Surgery, Grand Rapids Medical Education Partners/Michigan State University, Grand Rapids, MI, USA
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Randall J, Smyth E, McCarthy K, Dixon AR. Outcome of laparoscopic ventral mesh rectopexy for external rectal prolapse. Colorectal Dis 2014; 16:914-9. [PMID: 25110205 DOI: 10.1111/codi.12741] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 05/20/2014] [Indexed: 02/06/2023]
Abstract
AIM The study assessed the efficacy of laparoscopic ventral mesh rectopexy (LVMR) for full thickness external rectal prolapse (ERP), including recurrent prolapse. METHOD A prospective database identified all patients undergoing LVMR for ERP over the 16-year period to December 2013. Clinical outcome, Cleveland Clinic Incontinence Score (CCIS), quality of life (QOL) and patient-reported outcome were evaluated. RESULTS In total, 190 LVMRs (87% women) were performed during the study period, with a median active follow-up of 29 (1-196) months; 120 had a follow-up > 5 years and 16 > 10 years. The median time from surgery was 73 (1-196) months. The 60-day mortality, recurrence and mesh-related complication rates were 1%, 3% and 3.7%. The mean improvement in CCIS was 8 (P < 0.0001). Sixty-two patients returned a complete sequence of QOL scores (Birmingham Bowel and Urinary Symptoms Questionnaire 22), which had improved by 46% at year 1 and were sustained at a median of 4 years (P < 0.001). Mean patient-reported outcome measures for satisfaction at final review in 119 responders was 9.1/10. Thirty-nine patients underwent LVMR for recurrent ERP following perineal repair. Of these, full thickness recurrence occurred in one and there were no mesh complications. The same sustained improvement in QOL was observed. CONCLUSION LVMR for ERP is associated with low morbidity and recurrence and a long-term improvement in function and QOL. LVMR achieves the same benefits after a failed perineal procedure.
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Affiliation(s)
- J Randall
- University Hospitals Bristol, Bristol, UK
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31
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Zbar AP. Posterior pelvic floor disorders and obstructed defecation syndrome: clinical and therapeutic approach. ACTA ACUST UNITED AC 2014; 38:894-902. [PMID: 22415627 DOI: 10.1007/s00261-012-9878-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
There are no clear recommended imaging guidelines for the assessment of patients presenting primarily with obstructed defecation syndrome and defecation difficulty. The gold standard has always been the defecating proctogram which may require a rather poorly tolerated extended technique involving high-radiation exposure in young women which includes cystography, vaginography, small bowel opacification, and occasional peritoneography. The development of dynamic magnetic resonance imaging has obviated many of these extended techniques and may be supplemented by novel ultrasonographic methods including dynamic transperineal sonography, real-time 3D translabial ultrasound and 3D dynamic echodefecography. Patients potentially suitable for surgical treatment display a multiplicity of pelvic floor and perineal soft-tissue anomalies where one pathology (such as rectocele or enterocele) are considered dominant. Despite the introduction of recent stapled and robotic technologies, there is a dual dialog concerning the functional outcome of these procedures. Imaging and surgical algorithms for these patients are provided.
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Affiliation(s)
- Andrew P Zbar
- Department of Surgery and Transplantation, Chaim Sheba Medical Center, Tel Aviv Israel Affiliated with Sackler Medical School and Tel Aviv University, Tel Aviv, Israel,
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Mercer-Jones MA, D'Hoore A, Dixon AR, Lehur P, Lindsey I, Mellgren A, Stevenson ARL. Consensus on ventral rectopexy: report of a panel of experts. Colorectal Dis 2014; 16:82-8. [PMID: 24034860 DOI: 10.1111/codi.12415] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 08/06/2013] [Indexed: 02/06/2023]
Affiliation(s)
- M A Mercer-Jones
- Department of Colorectal Surgery, Queen Elizabeth Hospital, Gateshead, UK
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Formijne Jonkers HA, Poierrié N, Draaisma WA, Broeders IAMJ, Consten ECJ. Impact of rectopexy on sexual function: a cohort analysis. Int J Colorectal Dis 2013; 28:1579-82. [PMID: 23812007 DOI: 10.1007/s00384-013-1736-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/12/2013] [Indexed: 02/04/2023]
Abstract
PURPOSE Laparoscopic ventral rectopexy (LVR) is an established surgical technique for the treatment of both rectal prolapse and symptomatic rectoceles. It is, however, not known whether LVR influences sexual function (SF). The aim of this study was, therefore, to determine the impact of this procedure on the SF of patients. METHODS All female patients after LVR procedure in a single institution were identified and were sent a questionnaire concerning SF. This addressed sexual activity, satisfaction, preoperative SF, and the impact of surgery on SF. Furthermore, the PISQ-12 validated sexual functioning questionnaire was sent to all female patients. RESULTS A total of 217 patients were sent a questionnaire. These patients underwent LVR for rectal prolapse, symptomatic rectocele, or enterocele between 2004 and 2011. Mean age was 62 years (range 22-89). Mean follow-up was 30 months (range 5-83). Response rate was 64 % (139 patients). The number of sexual active patients dropped from 71 to 54 % after surgery. The number of patients being satisfied with their SF remained relatively equal; 91 % of patients before and 85 % of patients after surgery. Forty-three percent of patients stated that the LVR procedure did not influence their sexual function, in 16 % of patients, the procedure positively influenced their SF, and in 13 % of respondents, SF decreased after surgery. The mean PISQ-12 score postoperatively was 34 out of 48. CONCLUSIONS The impact of LVR on SF of patients seems limited in this cross-sectional study in a large cohort of patients.
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Affiliation(s)
- H A Formijne Jonkers
- Dept. of Surgery, Meander Medical Center, Utrechtseweg 160, 3818 ES, Amersfoort, The Netherlands
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34
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Kow N, Paraiso MFR. Robotic Approach to Pelvic Floor Disorders. CURRENT SURGERY REPORTS 2013. [DOI: 10.1007/s40137-013-0011-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Incontinence and constipation can occur in cases of pelvic floor dysfunction. Purely morphological changes without severe clinical symptoms are not an indication for surgery. Abdominal operations can be classified into procedures with dorsal (with or without bowel resection and with or without mesh implantation) and procedures with ventral rectopexy (with mesh). With respect to constipation and incontinence suture rectopexy alone is inferior to all other procedures. Dorsal and ventral mesh rectopexy and resection rectopexy are all comparable with respect to improvement of incontinence. Ventral rectopexy without dorsal mobilization and resection rectopexy are superior to mesh rectopexy with respect to constipation. Due to poor evidential status treatment is carried out from a pragmatic viewpoint.
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Affiliation(s)
- P Kienle
- Chirurgische Klinik, Universitätsklinikum Mannheim.
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36
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Mantoo S, Podevin J, Regenet N, Rigaud J, Lehur PA, Meurette G. Is robotic-assisted ventral mesh rectopexy superior to laparoscopic ventral mesh rectopexy in the management of obstructed defaecation? Colorectal Dis 2013; 15:e469-75. [PMID: 23895633 DOI: 10.1111/codi.12251] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Accepted: 12/30/2012] [Indexed: 12/18/2022]
Abstract
AIM Function, morbidity and recurrence of symptoms after robotic-assisted ventral mesh rectopexy (RVMR) and laparoscopic ventral mesh rectopexy (LVMR) for pelvic floor disorders (PFDs) were compared. METHOD Forty-four patients operated on for PFD with RVMR were compared with 74 of 144 patients who had had LVMR performed between 2008 and 2011. The groups were matched for age, body mass index, American Society of Anesthesiologists status and previous hysterectomy. The same surgical technique and type of mesh were used. Early postoperative morbidity and function [obstructed defaecation syndrome (ODS), incontinence scores (CCF) and sexual activity] were compared. RESULTS Operation time was longer in RVMR compared with LVMR (191 ± 26 vs 163 ± 39 min; P = 0.0002). RVMR showed less blood loss (8 ± 34 vs 42 ± 88 ml; P = 0.012) and fewer early complications (2% vs 11%; P = 0.019). ODS and CCF scores improved in both groups. Patients after RVMR reported a better improvement in digitation, straining and satisfaction after defaecation. There was a statistically significant difference in the postoperative ODS score in favour of RVMR (P = 0.004). Sexually active patients in both groups reported a similar improvement. There was no difference in early recurrence (P = 0.692). CONCLUSION Although not a randomized comparison, this study shows that ventral mesh rectopexy performed by the robot was followed by better function then LVMR.
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Affiliation(s)
- S Mantoo
- University Hospital of Nantes, Nantes, France
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37
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Formijne Jonkers HA, Poierrié N, Draaisma WA, Broeders IAMJ, Consten ECJ. Laparoscopic ventral rectopexy for rectal prolapse and symptomatic rectocele: an analysis of 245 consecutive patients. Colorectal Dis 2013; 15:695-9. [PMID: 23406289 DOI: 10.1111/codi.12113] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Accepted: 10/13/2012] [Indexed: 12/13/2022]
Abstract
AIM This retrospective study aimed to determine functional results of laparoscopic ventral rectopexy (LVR) for rectal prolapse (RP) and symptomatic rectoceles in a large cohort of patients. METHOD All patients treated between 2004 and 2011 were identified. Relevant patient characteristics were gathered. A questionnaire concerning disease-related symptoms as well as the Cleveland Clinic Incontinence Score (CCIS) and Cleveland Clinic Constipation Score (CCCS) was sent to all patients. RESULTS A total of 245 patients underwent operation. Twelve patients (5%) died during follow-up and were excluded. The remaining patients (224 women, nine men) were sent a questionnaire. Indications for LVR were external RP (n = 36), internal RP or symptomatic rectocele (n = 157) or a combination of symptomatic rectocele and enterocele (n = 40). Mean age and follow-up were 62 years (range 22-89) and 30 months (range 5-83), respectively. Response rate was 64% (150 patients). The complication rate was 4.6% (11 complications). A significant reduction in symptoms of constipation or obstructed defaecation syndrome was reported (53% of patients before vs 19% after surgery, P < 0.001). Mean CCCS during follow-up was 8.1 points (range 0-23, SD ± 4.3). Incontinence was reported in 138 (59%) of the patients before surgery and in 32 (14%) of the patients after surgery, indicating a significant reduction (P < 0.001). Mean CCIS was 6.7 (range 0-19, SD ± 5.2) after surgery. CONCLUSION A significant reduction of incontinence and constipation or obstructed defaecation syndrome after LVR was observed in this large retrospective study. LVR therefore appears a suitable treatment for RP and rectocele with and without associated enterocele.
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Powar MP, Ogilvie JW, Stevenson ARL. Day-case laparoscopic ventral rectopexy: an achievable reality. Colorectal Dis 2013; 15:700-6. [PMID: 23320615 DOI: 10.1111/codi.12110] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Accepted: 10/04/2012] [Indexed: 12/17/2022]
Abstract
AIM Laparoscopic ventral rectopexy (LVR) is a non-resectional technique for selected patients with full-thickness rectal prolapse and obstructed defaecation syndrome. Despite its challenges, LVR can be performed with relatively minimal patient trauma thus creating the potential for same-day discharge. Our aim was to assess the safety of day-case LVR and identify factors associated with same-day discharge. METHOD Data were prospectively collected on all patients (n = 120) from June 2008 to October 2011. Variables included demographics, perioperative details and postoperative course. Primary outcome was length of stay and secondary outcome was symptom improvement at the latest outpatient follow-up. Patients discharged the same day after LVR were compared with those who stayed overnight or longer. RESULTS Indications included rectocele and internal prolapse (47%), full-thickness rectal prolapse (44%) and other (9%). Mean operative time was 97 min, same-day discharge occurred with 23% (n = 27) and 67% (n = 80) were discharged on postoperative day 1. In terms of complications, 89% had none, 8% minor and 3% major, including one 24-h readmission for pain. Logistic regression identified younger age (P = 0.054) and private insurance status (P < 0.001) as being significantly associated with same-day discharge. Although surgical indication (P < 0.001), no prior hysterectomy (P = 0.012) and use of biological mesh (P = 0.012) had significant association they were probably confounded by age. CONCLUSION In selected patients with rectal prolapse or obstructed defaecation, same-day discharge after LVR is feasible and safe. Our analysis identified quicker discharge in the private system with younger patients. Nevertheless, in unselected patients 90% were discharged by the first operative day.
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Affiliation(s)
- M P Powar
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Smart NJ, Pathak S, Boorman P, Daniels IR. Synthetic or biological mesh use in laparoscopic ventral mesh rectopexy--a systematic review. Colorectal Dis 2013; 15:650-4. [PMID: 23517144 DOI: 10.1111/codi.12219] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Accepted: 12/04/2012] [Indexed: 12/11/2022]
Abstract
AIM Laparoscopic ventral mesh rectopexy (VMR) is a surgical option for internal and external rectal prolapse with low perioperative morbidity and low recurrence rates. Use of synthetic mesh in the pelvis may be associated with complications such as fistulation, erosion and dyspareunia. Biological meshes may avoid these complications, but the long-term outcome is uncertain. Debate continues as to which type of mesh is optimal for laparoscopic VMR. METHOD A literature search was performed of electronic databases including MEDLINE, Embase and Scopus (2000-12). Studies describing outcomes relating to the mesh were included for review. Only English language studies were included. RESULTS Thirteen observational studies reported the outcome of 866 patients following laparoscopic VMR. Eleven reported the outcome using synthetic mesh with a median follow-up ranging from 7 to 74 months. Two studies reported the outcome with biological mesh with a median follow-up of 12 months. Pooled analysis of the studies demonstrated that 767 patients had a repair with synthetic mesh and 99 with a biological implant. There was no difference in recurrence (3.7 vs 4.0%, P = 0.78) or mesh complications (0.7 vs 0%, P = 1.0%) between synthetic and biological mesh repair. CONCLUSION Biological meshes appear to be as effective as synthetic meshes in the short term for laparoscopic VMR. Mesh complication rates are low in both groups. Long-term follow-up is required to ascertain if these findings persist.
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Affiliation(s)
- N J Smart
- Exeter Surgical Health Services Research Unit (HeSRU), Royal Devon and Exeter NHS Foundation Trust, Exeter, UK.
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Healy DA, Murphy SP, Burke JP, Coffey JC. Artificial interfaces (“AI”) in surgery: Historic development, current status and program implementation in the public health sector. Surg Oncol 2013; 22:77-85. [DOI: 10.1016/j.suronc.2012.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Revised: 12/04/2012] [Accepted: 12/22/2012] [Indexed: 02/07/2023]
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van der Hagen SJ, van Gemert WG, Soeters PB, de Wet H, Baeten CG. Transvaginal posterior colporrhaphy combined with laparoscopic ventral mesh rectopexy for isolated Grade III rectocele: a prospective study of 27 patients. Colorectal Dis 2012; 14:1398-402. [PMID: 22405411 DOI: 10.1111/j.1463-1318.2012.03023.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
AIM The aim of this study was to evaluate prospectively transvaginal posterior colporrhaphy (TPC) combined with laparoscopic ventral mesh rectopexy (LVR) in patients with a symptomatic isolated rectocele. METHOD Patients with these complaints underwent dynamic and static MRI. All consecutive patients with a Grade III (4 cm or more) rectocele and without internal/external rectal prolapse, enterocele and external sphincter damage were operated on. The patients completed the Obstructed Defecation Syndrome (ODS) score and the Cleveland Clinic Incontinence Score (CCIS). All tests were repeated after treatment. Dynamic disorders of the pelvic floor detected by MRI were recorded. RESULTS In 27 patients [median age 67 (46-73) years], TPC combined with LVR was feasible. Complications were limited to port site infection in two patients. Sexual discomfort (n = 8) due to prolapse diminished in six (75%) patients and in one (4%) de novo dyspareunia developed after treatment. The median follow-up was 12 (10-18) months. The median CCIS was 12 (10-16) before treatment and 8 (7-10) after (P < 0.0001). The median ODS score was 19 (17-23) before and 6 (3-10) after treatment (P < 0.0001). There was no change in urinary symptoms. CONCLUSION TPC combined with LVR for obstructed defaecation and faecal incontinence in patients with Grade III rectocele significantly relieves the symptoms of these disorders.
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Affiliation(s)
- S J van der Hagen
- Department of Surgery, Refaja Hospital, Boerhaavestraat 1, Stadskanaal 9501 HE, The Netherlands.
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Abet E, Lehur PA, Wong M, Rigaud J, Darnis E, Meurette G. Sexual function and laparoscopic ventral rectopexy for complex rectocoele. Colorectal Dis 2012; 14:e721-6. [PMID: 22651543 DOI: 10.1111/j.1463-1318.2012.03113.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
AIM Laparoscopic ventral rectopexy (LVR) has recently been shown to be feasible, safe and efficient in restoring anatomy and improving rectal emptying in female patients presenting with a posterior pelvic floor prolapse. However, little is known about the sexual function of these patients. This study aimed to assess sexual activity in a group of patients referred for complex rectocoele and the consequences on sexual comfort of their treatment after LVR. METHOD We prospectively assessed 41 consecutive patients who underwent LVR (either laparoscopic or robotic-assisted) for symptomatic complex rectocoele from January 2009 to January 2010. We first identified sexually active patients in the cohort using a nonvalidated simplified questionnaire. The Brief Index Sexual Functioning for Women (BISF-W) questionnaire was used postoperatively to assess the impact of LVR on sexual function. Acceptability of the assessment of sexuality was also tested. The postoperative outcome of the sexually active patients was compared with data obtained from the French general population. RESULTS Among 38 patients in whom a successful LVR had been performed (three conversions), 22 (57.9%) were sexually active preoperatively and 18 (47.4%) were sexually active postoperatively at a mean of 7±4.2months of follow-up (P=0.44). No de novo dyspareunia was reported. At baseline, 13 patients experienced dyspareunia compared with six after LVR (P=0.02). A significant improvement in dyspareunia was observed (seven patients vs two patients; P=0.03). 19 (86%) of the 22 patients responded to the BISF-W questionnaire. The mean composite score was 26.7±8.2, with 63.2% of patients estimating sexual activity as important or very important. Compared with a reference population, sexual comfort was similar in LVR patients (32.2±12.6 vs 26.7±8.2; P=0.14). CONCLUSION Assessment of sexual function is accepted by the majority of patients suffering from pelvic floor disorders. In addition to the benefit on anatomical restoration and bowel function, LVR improves sexual function and dyspareunia in patients operated on for complex rectocoele.
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Affiliation(s)
- E Abet
- Clinique de Chirurgie Digestive et Endocrinienne, Institut des Maladies de l'Appareil Digestif, University Hospital of Nantes - Hôtel Dieu, Nantes, France
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Current world literature. Curr Opin Urol 2012; 22:336-45. [PMID: 22677776 DOI: 10.1097/mou.0b013e3283551cbf] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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