Sutureless laparoscopic rectopexy for procidentia

Berman, Irwin R.

doi:10.1007/bf02053762

Cited by 110 publications

(49 citation statements)

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“…In addition Hill et al [5] have reported the use of the endoscopic hernia stapler to control presacral hemorrhage in open rectal surgery. Berman et al described similar techniques employing laparoscopic sacral tacker and laparoscopic staplers to fix the mesh to the sacrum and rectum [1]. Laparoscopic sacral tackers have the obvious advantage of being hemostatic; however, we feel the mesh is best sutured to the side wall of the rectum.…”

Section: Discussionmentioning

confidence: 99%

Stapled laparoscopic rectopexy for rectal prolapse

et al. 1995

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The widespread success of laparoscopic cholecystectomy has led to the development of a wide range of laparoscopic surgical procedures. Procedures for treating rectal prolapse (Procidentia) may constitute some of the best applications for colorectal laparoscopic techniques. A technique of laparoscopic rectopexy performed using the endo-stapler is described. Twenty-nine consecutive patients have undergone laparoscopic rectopexy. The median age was 71 years (52-89), and male:female ratio was 27:2. One procedure had to be converted to open due to ventilatory difficulties. The mean operative time was 95 minutes (50-190). The mean hospital stay was 5 days (4-15). There was no mortality in this series. Morbidity included incisional hernia through a port hole (n = 1), extraperitoneal haematoma (n = 1), and urinary tract infection with retention (n = 1). In conclusion, laparoscopic abdominal rectopexy is a safe and effective technique in the management of rectal prolapse.

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Section: Discussionmentioning

confidence: 99%

Stapled laparoscopic rectopexy for rectal prolapse

et al. 1995

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“…Although there is currently no established consensus as to the best surgical treatment, a laparoscopic approach to rectal prolapse repair has become increasingly popular ever since its description in 1992 [8]. Several studies have shown the benefits of laparoscopy when compared to open rectopexy (OR) [9,10].…”

Section: Introductionmentioning

confidence: 99%

“…Traditionally, a perineal approach has been considered the operation of choice in any elderly or high-risk patient, because it was associated with lower perioperative morbidity, decreased pain, and a shorter length of hospital stay [6]. However, advances in minimally invasive techniques have called into question the optimal procedure for rectal prolapse, especially when considering long-term outcomes such as recurrence or anorectal function [7].Although there is currently no established consensus as to the best surgical treatment, a laparoscopic approach to rectal prolapse repair has become increasingly popular ever since its description in 1992 [8]. Several studies have shown the benefits of laparoscopy when compared to open rectopexy (OR) [9,10].…”

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confidence: 99%

Surgical treatments for rectal prolapse: how does a perineal approach compare in the laparoscopic era?

et al. 2014

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Background Patients with rectal prolapse often have significant comorbidities that lead surgeons to select a perineal resection for treatment despite a reported higher recurrence rate over abdominal approaches. There is a lack of data to support this practice in the laparoscopic era. The objective of this study was to evaluate if risk-adjusted morbidity of perineal surgery for rectal prolapse is actually lower than laparoscopic surgery.Design A retrospective review of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database as performed for patients undergoing surgical treatment of rectal prolapse between 2005 and 2011. Outcomes were analyzed according to procedure-type: laparoscopic rectopexy (LR), laparoscopic resection/rectopexy (LRR), open rectopexy (OR), open resection/rectopexy (ORR), and perineal resection (PR). A multivariate logistic regression was used to compare riskadjusted morbidity and mortality between each procedure. Main outcome measures were 30-day morbidity and mortality.Results Among 3,254 cases sampled, a laparoscopic approach was used in 22 %, an open abdominal approach in 30 %, and PR in 48 %. Patients undergoing PR were older (76) and had a higher ASA (3) compared to laparoscopic (58, 2) and open abdominal procedures (58, 2). Risk-adjusted mortality could not be assessed due to a low overall incidence of mortality (0.01 %). Overall morbidity was 9.3 %. ORR was associated with a higher risk-adjusted morbidity compared to PR (OR: 1.89 CI (1.19-2.99), p = 0.03). There were no significant differences in risk adjusted morbidity found between LR and LRR compared to PR p = 0.18;), p = 0.18). Laparoscopic cases averaged 27 min longer than open cases (p\0.001).Conclusion Laparoscopic rectal prolapse surgery has comparable morbidity and mortality to perineal surgery. A randomized trial is indicated to validate these findings and to assess recurrence rates and functional outcomes.The Delorme procedure for the surgical treatment of rectal prolapse was first described by the French surgeon Edmond Delorme in 1900 [1,2]. Since that time, over 100 different surgical procedures have been proposed for the management of this condition [3,4]. Although the majority of these procedures are now of only historical interest, many different techniques are still being used today. Procedures to address rectal prolapse can broadly be split into two main approaches-abdominal and perineal. The primary goals of the operation are to correct the prolapse, alleviate preoperative discomfort, and to prevent or improve fecal incontinence or constipation [5]. Traditionally, a perineal approach has been considered the operation of choice in any elderly or high-risk patient, because it was associated with lower perioperative morbidity, decreased pain, and a shorter length of hospital stay [6]. However, advances in minimally invasive techniques have called into question the optimal procedure for rectal prolapse, especially when considering long-term outcomes such as recurrence or an...

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“…After the first results of laparoscopic rectopexy [3, 4], minimally invasive surgery for rectal prolapse has been performed with increasing frequency.…”

Section: Introductionmentioning

confidence: 99%

Laparotomic vs. Laparoscopic Rectopexy in Complete Rectal Prolapse

et al. 1999

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Aim: The aim of this study was to compare the functional and clinical results of laparotomic and laparoscopic rectopexy in 2 homogeneous groups of patients with complete rectal prolapse and fecal incontinence. Methods: Between January 1989 and December 1997, twenty-three patients underwent abdominal rectopexy. Thirteen patients (group A, 12 females and 1 male, mean age 57.3, range 22–76 years), and 10 patients (group B, 10 females, mean age 52.3, range 26–70 years) were submitted respectively to either Wells laparotomic or laparoscopic rectopexy by the same surgical team using the same surgical technique and materials. Before the operation a detailed clinical history was collected, and the patients were studied by inspection and digital examination of the anorectum, proctosigmoidoscopy, pancolonic transit time, dynamic defecography, anorectal manometry and anal electromyography. After the operation all patients underwent perineal physiotherapy, external electric stimulation, and perineal biofeedback. Mean follow-up was 37.1 (range 6–90) months in group A and 25.7 (range 6–49) months in group B. Values were compared by χ², Mann-Whitney U, and Wilcoxon tests as appropriate. Differences were considered significant at p < 0.05. Results: In both groups dyschezia and fecal incontinence improved significantly (p < 0.05) after the operation. The basal pressure of the anal sphincter, squeezing pressure and rectoanal reflex improved without significance, and anal-perineal pain was not significantly reduced. In group B the postoperative hospital stay was lower than in group A, with a reduction in costs. Conclusion: Laparoscopic Wells rectopexy has the same clinical and functional results as laparotomic rectopexy, but with a shorter postoperative hospital stay and lower costs.

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Sutureless laparoscopic rectopexy for procidentia

Cited by 110 publications

References 1 publication

Stapled laparoscopic rectopexy for rectal prolapse

Stapled laparoscopic rectopexy for rectal prolapse

Surgical treatments for rectal prolapse: how does a perineal approach compare in the laparoscopic era?

Laparotomic vs. Laparoscopic Rectopexy in Complete Rectal Prolapse

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