Rectal Prolapse

BackgroundThe aim of this study was to assess, whether robotic-assistance in ventral mesh rectopexy adds benefit to laparoscopy in terms of health-related quality of life (HRQoL), cost-effectiveness and anatomical and functional outcome.MethodsA prospective randomized study was conducted on patients who underwent robot-assisted ventral mesh rectopexy (RVMR) or laparoscopic ventral mesh rectopexy (LVMR) for internal or external rectal prolapse at Oulu University Hospital, Finland, recruited in February-May 2012. The primary outcomes were health care costs from the hospital perspective and HRQoL measured by the 15D-instrument. Secondary outcomes included anatomical outcome assessed by pelvic organ prolapse quantification method and functional outcome by symptom questionnaires at 24 months follow-up.ResultsThere were 30 females (mean age 62.5 years, SD 11.2), 16 in the RVMR group and 14 in the LVMR group. The surgery-related costs of the RVMR were 1.5 times higher than the cost of the LVMR. At 3 months the changes in HRQoL were 'much better' (RVMR) and 'slightly better' (LVMR) but declined in both groups at 2 years (RVMR vs. LVMR, p > 0.05). The cost-effectiveness was poor at 2 years for both techniques, but if the outcomes were assumed to last for 5 years, it improved significantly. The incremental cost-effectiveness ratio for the RVMR compared to LVMR was €39,982/quality-adjusted life years (QALYs) at 2 years and improved to €16,707/QALYs at 5 years. Posterior wall anatomy was restored similarly in both groups. The subjective satisfaction rate was 87% in the RVMR group and 69% in the LVMR group (p = 0.83).ConclusionsAlthough more expensive than LVMR in the short term, RVMR is cost-effective in long-term. The minimally invasive VMR improves pelvic floor function, sexual function and restores posterior compartment anatomy. The effect on HRQoL is minor, with no differences between techniques.

BackgroundThe aim of this retrospective study was to evaluate morbidity, mortality, postoperative function and recurrences in patients treated by Altemeier's rectosigmoidectomy for complete rectal prolapse in a referral center for pelvic floor functional disorders.MethodsPeri-operative data on 43 consecutive female patients were reviewed. At follow-up any change in pelvic floor function and recurrences were determined. Thirty four patients were assessed at a median interval of 49 (2-135) months, six being deceased for reason not related to the prolapse and three lost to follow-up.ResultsPost-operative complications at 30 days occurred in 18 patients (38%). Major complication occurred in only one patient that was pneumonia with lung failure. Major complications were not related to the ASA score, BMI or age [average age 76.4]. There was no post-operative mortality at 30 days. At long-term follow-up functional results demonstrate a statistically significant decrease in the Obstructive Defecation Syndrome (ODS) score, but no statistically significant changes in the Vaizey score, the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) score and the urinary retention score. ODS score decreased with respect to levatorplasty and the change was statistically significant instead of Vaizey score in which were not. At the same follow-up there were 12 (35%) cases of recurrence with an estimated risk at 48 months of 40%. There were no statistically significant differences between patients with and without recurrence regarding age (p = 0.188), BMI (p = 0.864), ASA score (p = 0.433), previously repaired prolapse (p = 0.398), previous hysterectomy (p = 0.705), length of resected bowel (p = 0.126), and levatorplasty (p = 0.304). Patient satisfaction showed a mean of 8.8 and 6.4 respectively in patients without and with recurrences (p = 0.012).ConclusionsAltemeier's procedure had in our series low complications rate and no mortality. It offered improved evacuation in constipated patients while didn't improve fecal and urinary continence. Recurrence of prolapse was 40% at four years.

BackgroundExternal rectal prolapse (ERP) is a debilitating condition in which surgery plays an important role. The aim of this study was to evaluate the outcomes of abdominal approaches (AA) and perineal approaches (PA) to ERP.MethodsThis was a PRISMA-compliant systematic review with meta-analysis. Studies published between 1990 and 2021 were retrieved. The primary endpoint was recurrence at the last available follow-up. Secondary endpoints included factors associated with recurrence and function. All studies were assessed for bias using the Newcastle-Ottawa Scale and Cochrane tool.ResultsFifteen studies involving 1611 patients (AA = 817; PA = 794) treated for ERP were included, three of which were randomized controlled trials (RCTs; 114 patients (AA = 54; PA = 60)). Duration of follow-up ranged from 12 to 82 months. Recurrence in non-randomized studies was 7.7 per cent in AA versus 20.1 per cent in PA (odds ratio (OR) 0.29, 95 per cent confidence interval (c.i.) 0.17 to 0.50; P ConclusionThe overall risk of recurrence of ERP appears to be higher with PA versus AA. Incontinence is less frequent after AA but at the cost of increased constipation. Age at surgery and duration of follow-up are associated with increased risk of recurrence, which warrants adequate reporting of future studies on this topic.

AimRectopexy is the preferred abdominal intervention for rectal prolapse. Despite similar procedural steps - rectal mobilisation, prolapse reduction, and fixation - techniques vary widely, and onsensus on the optimal approach is lacking. This study aimed to assess global surgeon preferences and practices in rectopexy.MethodsAn international 28-item online survey was distributed between November 2023 and March 2024 through professional networks and social media. Questions addressed surgeon demographics, perioperative strategies, and technical approaches to rectopexy. Responses were analysed descriptively and stratified by region and specialty.ResultsA total of 226 surgeons from 36 countries across four continents completed the survey. Most respondents (79.6%) administered preoperative intravenous antibiotics, and 80.5% used some form of mechanical bowel preparation. Minimally invasive approaches predominated (81%), with laparoscopy being most common. Posterior dissection was preferred by 61.5%, while 38.5% favoured ventral (anterior) dissection. Two-thirds (68.1%) routinely used mesh, predominantly synthetic. Only 15% performed rectopexy as a day-case procedure. Regional and specialty-related variations were evident in approach, mesh type, and perioperative protocols.ConclusionThis international survey reveals marked variability in rectopexy practice worldwide. Despite common principles, surgeon preference and regional factors strongly influence decision-making. The findings emphasise the need for updated international guidelines to harmonise technique selection and perioperative management in rectal prolapse surgery.