Laparoscopic surgery for rectal prolapse and pelvic floor disorders

Table 1 Abdominal procedures for pelvic floor disorders

Type of procedure	Operation technique
Suture rectopexy (Sudeck)	Complete rectal mobilisation to level of levators
	Suture of rectum to presacral fasica
Anterior sling rectopexy (Ripstein)	Complete rectal mobilisation to level of levators circular wrapping of mesh around rectum and attachment to the promontory
Lateral mesh rectopexy (Orr-Loygue)	Anterior + posterior complete rectal mobilisation fixation by two lateral mesh strips to promontory
Ventral mesh rectopexy (D'Hoore)	Strictly anterior rectal dissection to level of levators
	Fixation of mesh strip on distal rectum and to promontory
Posterior mesh rectopexy (Wells)	Complete rectal mobilisation to level of levators
	Semicircular mesh around rectum posterior, fixation to promontory
Resection rectopexy	Complete rectal mobilisation to level of levators sigmoid resection and suture fixation of rectum to promontory
(Frykman-Goldberg)
Rectal mobilisation without rectopexy	Complete rectal mobilisation to level of levators no fixation

Table 2 Outcome of laparoscopic procedures for pelvic floor disorders

	Minor compl.	Major compl.	Mortality	Conversion	Incontinence	Constipation	Recurrence
LSR	0%-16%	2%-11%	0%	0%-5%	48%-82% (+)	11% (-)-70% (+)	2%-20%
LMR	0%-5%	0%-3%	0%	0%-5%	76%-92% (+)	38% (-)-36% (+)	1.3%-6%
LVR	0%-36%	0%-5%	0%-0.4%	0%-7.4%	70%-90% (+)	60%-80% (+)	0%-14%
LRR	11%-21%	0%-4%	0%-0.8%	0%-6%	62%-94% (+)	53%-80% (+)	0%-11%

Data from studies that report data of laparoscopic rectopexy. Incontinence/constipation: Improvement (+), worsening (-); Minor compl.: Dindo  I-II; Major compl.: Dindo III-IV. LSR: Lap. suture rectopexy; LMR: Lap. mesh rectopexy (Wells, Orr-Loygue); LVR: Lap. ventral rectopexy; LRR: Lap. resection rectopexy.

Table 3 Comparative rectopexy studies (open vs laparoscopic, different procedures)

Study	Procedure	Patients	Results
Sajid (2009)	LR	330	No difference in Mort, Morb, Inc, Cons, recurrence shorter hospital stay for LR
Meta-analysis (12 studies) different procedures	OR	358	Shorter operation times for OR
Caddedu (2012)	LR	192	No difference in Mort, Morb, Inc, Cons, recurrence
Meta-analysis (8 studies)	OR	275
different procedures
Senapeti (2013)	SR	38	No difference in morbidity, recurrence and functional outcome
Randomised	RR	40
Forminje (2014)	LVR	40	More minor complications in LRR
Retrospective	LRR	28	No difference in major complications, recurrence and functional outcome
Sahoo (2014)	LPR	38	No differences in morbidity, recurrence and functional outcome
Retrospective	LSR	32
Lechaux (2004)	LRR	13	Significant more patients with worsening of constipation in the LMR-group (26% vs 8%)
Prospective	LMR	35	No differences in morbidity and improvement of continence
Madbouly (2002)	LRR	12	No difference in complications and functional outcome
Prospective	LPR	12

Data from studies that compare open vs laparoscopic rectopexies or studies that compare different procedures. Mort: Mortality; Morb: Morbidity; Inc: Faecal incontinence; Cons: Constipation; LR: Laparoscopic rectopexy; OR: Open rectopexy; SR: Suture rectopexy; RR: Resection rectopexy; LPR: Laparoscopic posterior mesh rectopexy; HS: Hospital stay; OT: Operation time.