Patients’ Perception of Long-term Outcome After Laparoscopic Ventral Mesh Rectopexy; Single Tertiary Center Experience

Abstract

Objective: To assess patients' long-term outcome and satisfaction after laparoscopic ventral mesh rectopexy (LVMR). Summary of Background Data: Data on the long-term outcome and satisfaction of patients undergoing LVMR are limited. Methods: Patients who underwent LVMR between 2004 and 2017 were identified from a prospectively maintained database. We attempted to contact all patients by telephone for an interview using a standardized questionnaire to record pre-LVMR symptoms, long-term outcome, and overall satisfaction. Results: Total number of patients who underwent LVMR was 848 and 99 (12%) were deceased at follow-up. In the end, 544 (64%) patients were contacted successfully and 478 (56%) were able to complete the questionnaire. Median time elapsed since surgery was 7 years and mean age was 62 years. Patients' reported preoperative symptoms were obstructed defecation syndrome in 40%, fecal incontinence in 22%, combination of obstructed defecation syndrome and fecal incontinence in 21% and other conditions in 17%. Bowel symptoms were reported as improved by 69% of patients and worse by 12%. Pelvic pain was reported to be improved in 47% of the patients after LVMR but new onset of pelvic pain appeared in 15%. Sexual function was reported to be better and worse with equal frequency. Overall, 63% of the patients were satisfied with the outcome and 76% would recommend this procedure to others with similar symptoms. Conclusion: LVMR offers acceptable long-term outcomes and satisfaction. There is a mixed impact on pelvic pain and sexual function which requires careful consideration in counseling patients for this procedure.

Pelvic pain is a common prolapse symptom and improvement after ventral mesh rectopexy is more frequent than deterioration or de novo pain

“…As described in our previous paper, we were able to successfully contact 478 (64%) of the 749 patients who underwent VMR between 2004 and 2017 [15]. When questioned, 187 patients (39%) reported pelvic pain prior to VMR (group A) and 291 (61%) recalled no pelvic pain before VMR (group B).…”

Ninety‐day morbidity of robot‐assisted redo surgery for recurrent rectal prolapse, mesh erosion and pelvic pain: lessons learned from 9 years’ experience in a tertiary referral centre

“…Although concerns about post‐VMR pelvic pain have increased, the prevalence of this complaint is understudied. Only recently a retrospective study was published describing de novo pelvic pain in 15% of patients after VMR [ 19 ]. Although the indication for redo surgery in cases of therapy‐resistant chronic pelvic pain is not straightforward, with the growing resistance to synthetic mesh we think it is important to publish on this type of surgery and its outcome.…”

“…The incidence of pelvic pain is understudied and only recently a first retrospective study described de novo pelvic pain in 15% of patients [19]. Currently, there are no data on the outcome of redo surgery for therapy-resistant pelvic pain [20].…”

“…A third group consists of patients with therapy‐resistant pelvic pain, without evidence of mesh erosion, who request mesh removal. The incidence of pelvic pain is understudied and only recently a first retrospective study described de novo pelvic pain in 15% of patients [ 19 ]. Currently, there are no data on the outcome of redo surgery for therapy‐resistant pelvic pain [ 20 ].…”

Resultados funcionales en el tratamiento del prolapso rectal

“…Se estima que la cirugía fracasa en un 20-30% de los casos 4 . En las últimas 3-4 décadas se ha introducido un número importante de técnicas quirúrgicas abdominales, con objeto de corregir tanto el prolapso interno como externo asociado a síndrome de bloqueo defecatorio y/o incontinencia 5 . Tradicionalmente los procedimientos perineales se han reservado para pacientes añosos, no aptos a tolerar una cirugía por vía abdominal 6 .…”