Sutured posterior abdominal rectopexy with sigmoidectomy compared with Marlex® rectopexy for rectal prolapse

Abstract

Two treatment policies for rectal prolapse were prospectively assessed between April 1986 and January 1989. Sixteen patients had a Marlex mesh posterior rectopexy alone and 13 underwent a sigmoidectomy combined with a sutured posterior rectopexy. Preoperative and post-operative assessment included manometry, a saline infusion test and video-proctography. Hospital stay, control of prolapse and complications were comparable in both groups. Restoration of continence occurred in nine of the 12 incontinent patients after Marlex rectopexy, compared with six of nine after sutured rectopexy and sigmoidectomy. Constipation persisted in three patients who were constipated before operation and in four of 13 who had previously normal bowel habits became constipated after Marlex rectopexy; constipation persisted in one of five previously constipated patients while none with previously normal bowel habits became constipated after sutured rectopexy and sigmoidectomy. Sigmoidectomy combined with sutured rectopexy was safe and as efficient as Marlex rectopexy in prolapse control and improvement of continence; significantly fewer patients were constipated (one of 13) after sigmoidectomy than following rectopexy alone (seven of 16). A randomized trial now seems justified.

Laparoscopic Suture Rectopexy: An Effective Treatment for Complete Rectal Prolapse

“…In the postoperative period, 9 (60%) of these 16 patients improved as regards their constipation. Constipation is a common problem after rectopexy, particularly so after posterior mesh rectopexy [24]. Studies have demonstrated that constipation increased from 10-47% and suggested a link with denervating the left colon and rectum with possible kinking at the recto-sigmoid junction by a redundant, unresected sigmoid colon prolapsing into the pouch of Douglas [24].…”

“…Constipation is a common problem after rectopexy, particularly so after posterior mesh rectopexy [24]. Studies have demonstrated that constipation increased from 10-47% and suggested a link with denervating the left colon and rectum with possible kinking at the recto-sigmoid junction by a redundant, unresected sigmoid colon prolapsing into the pouch of Douglas [24]. This may be specially so because the lateral ligaments containing the parasympathetic inflow to the left colon may be cut during mobilization.…”

“…Improvement in the degree of constipation in our study can be attributed to the surgical technique used when the lateral ligaments were not divided for rectal mobilization. The use of prosthetic mesh in posterior mesh rectopexy to induce fibrosis and promote fixation is associated with sepsis and a higher incidence of constipation [24,27]. Suture rectopexy has been shown to be equally effective as mesh rectopexy in preventing recurrence but avoids the problems of post operative sepsis and increased constipation [28].…”

“…However, a colonic resection requires a colonic anastomosis and an abdominal incision to retrieve the specimen, making it technically demanding and time consuming [5]. Laparoscopic posterior mesh rectopexy without resection has the problems of increased constipation after surgery in addition to increased cost of the mesh [7]. On the other hand, suture rectopexy without resection may be regarded as an ideal laparoscopic procedure in that it can be performed entirely intracorporeally and by avoiding the use of a mesh improve functional results such as constipation.…”

Perineal Stapled Prolapse Resection

“…Fifteen percent of patients experience constipation for the first time following rectopexy, and at least 50 % of those who are constipated preoperatively are made worse [22]. The addition of sigmoidectomy to the operation was felt to be associated with a lower recurrence rate and improved functional outcome with a minimal increase in morbidity [23,24]. It seems to reduce constipation significantly in those who report this symptom preoperatively in some studies [23,25,26].…”