Journal of Surgery
IntroductionLaparoscopic ventral mesh rectopexy (LVMR) is gaining wider acceptance amongst colorectal surgeons as the technique that can address symptoms of both external and internal rectal prolapse. It also allows correction of any associated rectocele, enterocele and posterior vaginal wall prolapse as well as vault prolapse. The learning curve for LVMR is unknown and there is no consensus on case selection. The aim of this study is to share our results to show that LVMR can be learnt and safely performed by experienced laparoscopic colorectal surgeons in district general hospitals with short term results similar to that of establish centres.
MethodologyPrior to start of this retrospective study UK National Health Service Health Research Authority website was consulted and NHS Research Ethics Committee approval was not required. The procedures followed were in accordance with the principles of the Helsinki Declaration of 1975, as revised in 2000.Laparoscopic Ventral Mesh Rectopexy was started at our institution in January 2011. All patients presented with obstructed defecation syndrome (ODS) and rectal prolapse from January 2011 to January 2015 are included in this analysis. Patients presenting to the out patients department with symptoms of difficulty in evacuation, sense of incomplete evacuation, pelleted stools, frequent visits to the toilet, perineal, vaginal or anal digitation, incontinence and pelvic pain were clinically diagnosed as having obstructed defecation. All with such symptoms were investigated with anorectal physiology, defecation proctography, colon transit studies, colonoscopy or sigmoidoscopy as appropriate. Patients with obvious rectal prolapse underwent either colonoscopy or sigmoidoscopy as indicated.Fluoroscopic defecography was performed with vaginal, oral and bladder contrast. Defecography, anorectal physiology and symptoms were discussed in the fortnightly pelvic floor MDT which consists of two colorectal surgeons (both authors), one radiologist, the radiographer who performs defecography, one urogynaecologist and the colorectal nurse specialist who performs anorectal physiology and biofeedback. Fluoroscopy films were reviewed by all MDT members and intussusception was graded according to oxford prolapse grade [1] (Grade 1-High recto rectal intussusception, Grade 2-Low recto-rectal intussusception, Grade 3-High recto-anal intussusception, Grade 4-Low recto-anal intussusception, Grade 5-Complete rectal prolapse). Evacuation time, number of attempts at evacuation and speed of opening of the anal canal were considered as subjective global markers of evacuation efficiency. In the case of rectocele barium trapping in the rectocele was considered significant. All patients with ODS then underwent maximal medical therapy as well as biofeedback. Since 2012 patients are offered trans anal irrigation as a form of conservative treatment if they do not respond to maximal medical therapy. Patients with high grade intussusception (Grade 3 and 4) and reduced
AbstractIntroduction: ...