Predictive Factors for Recurrence of External Rectal Prolapse after Laparoscopic Ventral Rectopexy

Abstract

Objectives: This study aimed to evaluate factors that contribute to the recurrence of external rectal prolapse (ERP) following laparoscopic ventral rectopexy (LVR). Methods: All patients who underwent LVR using synthetic meshes between 2011 and 2018 were prospectively included. A standard questionnaire including the Fecal Incontinence Severity Index (FISI) and Constipation Scoring System (CSS) was administered preoperatively and postoperatively. Defecography was performed 6 months postoperatively. Univariate and backward stepwise multivariate Cox analysis was performed to determine the prognostic factors of recurrence. Results: In total, 132 patients with a median follow-up of 46 months were included. The overall recurrence rate was 6.8% (n = 9), as confirmed by defecography at 6 months in six of the patients. None of the patients developed mesh erosion. FISI and CSS scores were significantly reduced at 3 months and remained significantly reduced for 3 years. Multivariate analyses revealed that the predictors of recurrence included male sex (hazards ratio, 11.3; 95% confidence interval, 3.0-43.0) and age >80 years (hazards ratio, 10.7; 95% confidence interval, 1.3-86.3). Eight patients with recurrence underwent surgery via Delorme's procedure (n = 7) and posterior rectopexy (n = 1). Two patients with new-onset rectoanal intussusception and one with uncorrected sigmoidocoele underwent repeat LVR. Conclusions: LVR is effective in treating ERP with low morbidity and low recurrence. Male patients and patients older than 80 years are at increased risk of recurrence. Hence, the LVR technique should be modified or coupled with other perineal procedures when treating ERP, especially in male patients.

Comparative study of laparoscopic ventral mesh rectopexy versus perineal stapler resection for external full-thickness rectal prolapse in elderly patients: enhanced outcomes and reduced recurrence rates—a retrospective cohort study

“…In our assessment for LVMR, although there were differences in symptom improvement compared to other studies, postoperative FI showed a significant improvement of 95.5% at the 4-year follow-up, whereas ODS demonstrated a significant improvement of 92.3%. These findings are consistent with another study [ 42 ]. The observed improvement in ODS symptoms after LVMR can be attributed to the autonomic nerve-sparing surgical technique [ 9 ].…”

Comparison of Safety and Efficacy between Laparoscopic Ventral Rectopexy and Delorme's Procedure for External Rectal Prolapse in Nonagenarians

“…While, a recent study has reported a lower recurrence rate (4.3%, 2 out of 47 cases) for the modified Delorme's procedure, where the length of stripped rectal mucosa was maintained 3 to 4 times the length of the exteriorized prolapse [20], a comprehensive review article highlighted a lower recurrence rate for ERP after LVR when compared to Delorme's procedure (2% [15/680] versus 20% [154/ 770]) [19]. However, considering reports of increased recurrence risk in older patients post-LVR [21,22], and the observation that all recurrences (nine out of 132 patients) occurred within the initial 12 months post-surgery [14], a follow-up period of at least 12 months is recommended, even for nonagenarian patients.…”

Long-term outcomes of robot-assisted versus laparoscopic ventral mesh rectopexy for rectal prolapse and rectal intussusception

“…The most common technical cause of recurrence or repair failure is due to mesh detachment from the sacral promontory [11]. Other reported risk factors for recurrence after LVR include age >70, male sex, high BMI, and prolonged pudendal nerve terminal motor latency, none of which are related to the surgical technique [12,13]. With experienced laparoscopic surgeons doing precise dissection of the rectovaginal septum and adequate xation of the mesh to the lower rectum and the sacral promontory, we would not expect signi cant difference in outcomes with RVR and LVR.…”