CC BY 4.0 · Surg J (N Y) 2018; 04(04): e205-e211
DOI: 10.1055/s-0038-1675358
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Laparoscopic Ventral Mesh Rectopexy: Functional Outcomes after Surgery

Nasir Zaheer Ahmad
1   Department of Colorectal Surgery, Queen Alexandra Hospital, Portsmouth, United Kingdom
Samuel Stefan
1   Department of Colorectal Surgery, Queen Alexandra Hospital, Portsmouth, United Kingdom
Vidhi Adukia
1   Department of Colorectal Surgery, Queen Alexandra Hospital, Portsmouth, United Kingdom
Syed Abul Hassan Naqvi
1   Department of Colorectal Surgery, Queen Alexandra Hospital, Portsmouth, United Kingdom
Jim Khan
1   Department of Colorectal Surgery, Queen Alexandra Hospital, Portsmouth, United Kingdom
› Author Affiliations
Further Information

Publication History

30 March 2018

10 September 2018

Publication Date:
29 October 2018 (online)


Aims Rectal prolapse is a debilitating and unpleasant condition adversely affecting the quality of life. Laparoscopic ventral mesh rectopexy (LVMR) is recognized as one of the treatment options. The aim of this study was to evaluate the functional outcomes after a standardized LVMR.

Methods A cohort of patients who underwent LVMR from 2011 to 2015 were contacted and asked to fill questionnaires about their symptoms before and after the surgery. Three questionnaires based on measurement of Wexner fecal incontinence (WFI), obstructive defecation syndrome (ODS), and Birmingham Bowel and Urinary Symptom (BBUS) scores were used to assess the changes in postoperative functional outcomes. Some additional questions were also added to further assess bowel dysfunction.

Results There were 58 female patients with a mean age of 62.74 ± 15.20 (26–86) years in this cohort. About 70% of the patients participated in the study and returned the filled questionnaires. There was a significant overall improvement across all three scores (WFI: p = 0.001, ODS: p = 0.001, and BBUS: p = 0.001). Some individual components in the scoring systems did not improve to patient's satisfaction. No perioperative complication or conversion to an open procedure was reported in this study. Three recurrences were seen in the redo cases.

Conclusion LVMR is a promising way of dealing with rectal prolapse. A careful patient selection, appropriate preoperative workup, and a meticulous surgical technique undoubtedly transform the postoperative outcomes.

  • References

  • 1 Graham RR. The operative repair of massive rectal prolapse (1942). Ann Surg 1942; 115 (06) 1007-1014
  • 2 Watson DI, Thompson SK, Devitt PG. , et al. Laparoscopic repair of very large hiatus hernia with sutures versus absorbable mesh versus nonabsorbable mesh: a randomized controlled trial. Ann Surg 2015; 261 (02) 282-289
  • 3 Maglinte DD, Kelvin FM, Fitzgerald K, Hale DS, Benson JT. Association of compartment defects in pelvic floor dysfunction. AJR Am J Roentgenol 1999; 172 (02) 439-444
  • 4 Rinne KM, Kirkinen PP. What predisposes young women to genital prolapse?. Eur J Obstet Gynecol Reprod Biol 1999; 84 (01) 23-25
  • 5 Mäkelä-Kaikkonen JK, Rautio TT, Koivurova S. , et al. Anatomical and functional changes to the pelvic floor after robotic versus laparoscopic ventral rectopexy: a randomised study. Int Urogynecol J Pelvic Floor Dysfunct 2016; 27 (12) 1837-1845
  • 6 Wong MTC, Abet E, Rigaud J, Frampas E, Lehur PA, Meurette G. Minimally invasive ventral mesh rectopexy for complex rectocoele: impact on anorectal and sexual function. Colorectal Dis 2011; 13 (10) e320-e326
  • 7 Madoff RD, Mellgren A. One hundred years of rectal prolapse surgery. Dis Colon Rectum 1999; 42 (04) 441-450
  • 8 Penninckx F, D'Hoore A, Sohier S, Kerremans R. Abdominal resection rectopexy versus Delorme's procedure for rectal prolapse: a predictable outcome. Int J Colorectal Dis 1997; 12 (01) 49-50
  • 9 Williams JG, Rothenberger DA, Madoff RD, Goldberg SM. Treatment of rectal prolapse in the elderly by perineal rectosigmoidectomy. Dis Colon Rectum 1992; 35 (09) 830-834
  • 10 Marchal F, Bresler L, Ayav A. , et al. Long-term results of Delorme's procedure and Orr-Loygue rectopexy to treat complete rectal prolapse. Dis Colon Rectum 2005; 48 (09) 1785-1790
  • 11 Smart NJ, Pathak S, Boorman P, Daniels IR. Synthetic or biological mesh use in laparoscopic ventral mesh rectopexy--a systematic review. Colorectal Dis 2013; 15 (06) 650-654
  • 12 D'Hoore A, Cadoni R, Penninckx F. Long-term outcome of laparoscopic ventral rectopexy for total rectal prolapse. Br J Surg 2004; 91 (11) 1500-1505
  • 13 Randall J, Smyth E, McCarthy K, Dixon AR. Outcome of laparoscopic ventral mesh rectopexy for external rectal prolapse. Colorectal Dis 2014; 16 (11) 914-919
  • 14 Jorge JMN, Wexner SD. Etiology and management of fecal incontinence. Dis Colon Rectum 1993; 36 (01) 77-97
  • 15 Zhang B, Ding JH, Yin SH, Zhang M, Zhao K. Stapled transanal rectal resection for obstructed defecation syndrome associated with rectocele and rectal intussusception. World J Gastroenterol 2010; 16 (20) 2542-2548
  • 16 Hiller L, Radley S, Mann CH. , et al. Development and validation of a questionnaire for the assessment of bowel and lower urinary tract symptoms in women. BJOG 2002; 109 (04) 413-423
  • 17 Classic articles in colonic and rectal surgery. Edmond Delorme 1847-1929. On the treatment of total prolapse of the rectum by excision of the rectal mucous membranes or recto-colic. Dis Colon Rectum 1985; 28 (07) 544-553
  • 18 Riansuwan W, Hull TL, Bast J, Hammel JP, Church JM. Comparison of perineal operations with abdominal operations for full-thickness rectal prolapse. World J Surg 2010; 34 (05) 1116-1122
  • 19 Dolk A, Brodén G, Holmström B, Johansson C, Nilsson BY. Slow transit of the colon associated with severe constipation after the Ripstein operation. A clinical and physiologic study. Dis Colon Rectum 1990; 33 (09) 786-790
  • 20 Siproudhis L, Ropert A, Gosselin A. , et al. Constipation after rectopexy for rectal prolapse. Where is the obstruction?. Dig Dis Sci 1993; 38 (10) 1801-1808
  • 21 Eu KW, Seow-Choen F. Functional problems in adult rectal prolapse and controversies in surgical treatment. Br J Surg 1997; 84 (07) 904-911
  • 22 Faucheron JL, Trilling B, Girard E, Sage PY, Barbois S, Reche F. Anterior rectopexy for full-thickness rectal prolapse: technical and functional results. World J Gastroenterol 2015; 21 (16) 5049-5055
  • 23 Solomon MJ, Young CJ, Eyers AA, Roberts RA. Randomized clinical trial of laparoscopic versus open abdominal rectopexy for rectal prolapse. Br J Surg 2002; 89 (01) 35-39
  • 24 Samaranayake CB, Luo C, Plank AW, Merrie AE, Plank LD, Bissett IP. Systematic review on ventral rectopexy for rectal prolapse and intussusception. Colorectal Dis 2010; 12 (06) 504-512
  • 25 Wong M, Meurette G, Abet E, Podevin J, Lehur PA. Safety and efficacy of laparoscopic ventral mesh rectopexy for complex rectocele. Colorectal Dis 2011; 13 (09) 1019-1023
  • 26 Madiba TE, Baig MK, Wexner SD. Surgical management of rectal prolapse. Arch Surg 2005; 140 (01) 63-73
  • 27 Bachoo P, Brazzelli M, Grant A. Surgery for complete rectal prolapse in adults. Cochrane Database Syst Rev 2000; ; ( (02) CD001758
  • 28 Tou S, Brown SR, Malik AI, Nelson RL. Surgery for complete rectal prolapse in adults. Cochrane Database Syst Rev 2008; ; ( (04) CD001758
  • 29 Bloemendaal ALA, Mishra A, Nicholson GA. , et al. Laparoscopic rectopexy is feasible and safe in the emergency admission setting. Colorectal Dis 2015; 17 (10) O198-O201
  • 30 Powar MP, Ogilvie Jr JW, Stevenson ARL. Day-case laparoscopic ventral rectopexy: an achievable reality. Colorectal Dis 2013; 15 (06) 700-706
  • 31 Mehmood RK, Parker J, Bhuvimanian L. , et al. Short-term outcome of laparoscopic versus robotic ventral mesh rectopexy for full-thickness rectal prolapse. Is robotic superior?. Int J Colorectal Dis 2014; 29 (09) 1113-1118
  • 32 Badrek-Al Amoudi AH, Greenslade GL, Dixon AR. How to deal with complications after laparoscopic ventral mesh rectopexy: lessons learnt from a tertiary referral centre. Colorectal Dis 2013; 15 (06) 707-712
  • 33 Tranchart H, Valverde A, Goasguen N, Gravié JF, Mosnier H. Conservative treatment of intrarectal mesh migration after ventral laparoscopic rectopexy for rectal prolapse. Int J Colorectal Dis 2013; 28 (11) 1563-1566
  • 34 Van Iersel JJ. Formijne Jonkers HA, Verheijen PM, Draaisma WA, Consten EC, Broeders IA. High grade haemorrhoids requiring surgical treatment are common after laparoscopic ventral mesh rectopexy. Tech Coloproctol 2016; 20 (04) 235-242