Long-Term Outcome after Resection Rectopexy for Internal Rectal Intussusception

Abstract

Background and Aims. The optimal treatment of patients with internal rectal intussusception (IRI) is unresolved. The aim was to study the short- and long-term outcome of resection rectopexy in these patients. Methods. An observational and mainly prospective study of 48 patients (44 women) with IRI who had ligament-preserving suture rectopexy by laparoscopic (n = 25) or open (n = 23) technique. Outcome measures were morbidity, scores for constipation and anal incontinence, patients' report, and health-related quality of life (HRQoL). Results. From preoperatively to a median of 6 months and 76 months postoperatively, constipation scores were reduced from a mean of (95% CI) 13.20 (11.41 to 15.00) to 6.91 (5.29 to 8.54) and 6.35 (4.94 to 7.76) (P < 0.0001). The number of constipated patients was reduced from 35 to eleven and eight, respectively, and none became constipated. Nine of ten symptoms of constipation improved. Corresponding scores for anal incontinence were 4.7 (2.4–7.0), 4.0 (2.4–5.7), and 4.1 (2.3–5.8), respectively. HRQoL at long-term followup compared to the general Norwegian population was reduced in four out of eight dimensions concerning physical factors. The patient-reported outcome at short- and long-term followup was improved by 85.4% and 75.0%, respectively. Conclusions. Resection rectopexy for IRI improved the outcome. HRQoL was reduced compared with the general population.

Abdominal rectopexy for the treatment of internal rectal prolapse: a systematic review and meta‐analysis

“…Ventral mesh rectopexy, as described by D'Hoore et al . , was reported in ten studies and resection rectopexy in four . Abdominal rectopexy was performed laparoscopically in all the studies and in four open rectopexy was also used (Table ).…”

“…All patients had internal rectal prolapse (IRP) diagnosed clinically, by defaecography and/or by examination under anaesthesia. Eight studies , including 971 patients, reported the presence of a concomitant anterior rectocele in 671 (69.1%) patients. Ten studies, which included 1158 patients, classified rectoanal intussusception according to the Oxford grading system as Grade I–II in 50 (4.4%) patients and Grade III–V in 1108 (95.6%).…”

“…Seven studies reported new‐onset or worsening of OD in a median of 4.5 (2.4–11.5)% of patients. Five studies reported new‐onset or worsening of FI in a median of 7.5 (3.1–14.5)% of patients. Symptoms as assessed by functional bowel scoring systems improved in six studies .…”

“…After reviewing the full text of 42 articles, 14 [14][15][16][17][18][19][20][21][22][23][24][25][26][27] met the eligibility criteria for inclusion. Thirteen studies were noncomparative cohort studies, and one was a trial comparing ventral rectopexy with STARR.…”

“…The exception was a nonrandomized comparison between ventral rectopexy and STARR. Ventral mesh rectopexy, as described by D'Hoore et al [30], was reported in ten studies and resection rectopexy in four [14][15][16]19]. Abdominal rectopexy was performed laparoscopically in all the studies and in four [14,15,18,19] open rectopexy was also used ( Table 1).…”