Short term outcome of laparoscopic ventral mesh rectopexy for rectal and complex pelvic organ prolapse: case series

Abstract

Objective: 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.

Ethics committee approval was received for this study from the Ethics Committee of Zonguldak Bulent Ecevit University Clinical Research (2018/137).

Written informed consent was obtained from patients who participated in this study.

Externally peer-reviewed.

Consept - F.A.G.; Design - F.A.G.; Supervision - F.A.G.; Resource - F.A.G.; Materials - F.A.G.; Data Collection and/or Processing - F.A.G.; Analysis and Interpretation - F.A.G.; Literature Search - F.A.G.; Writing Manuscript - F.A.G.; Critical Reviews - F.A.G.

The author declares that she has no conflict of interest.

The authors declared that this study has received no financial support.

The author thank to Furuzan Kokturk, Assistant Professor of Department of Biostatistics, Faculty of Medicine, Zonguldak Bulent Ecevit University, for their contribution in the acquisition of data.