Abdominal ventral rectopexy with colectomy for obstructed defecation syndrome:An alternative option for selected patients

BACKGROUND Abdominal ventral rectopexy(AVR)with colectomy is controversial in the treatment of obstructed defecation syndrome(ODS).Literature data on this technique for ODS are very limited.AIM To evaluate the safety and efficacy of AVR with colectomy for selected patients with ODS.METHODS Consecutive patients who underwent AVR with colectomy for ODS were identified prospectively from 2016 to 2017 in our department.Patient demographics,perioperative surgical results,and postoperative follow-up outcomes were collected and analyzed.Long-term follow-up was evaluated with standardized questionnaires.The severity of symptoms was assessed by the objective Wexner Constipation Score(WCS)and ODS Score.The quality of life was assessed by the Patients Assessment of Constipation Quality of Life score.Functional outcome was compared pre-and post-operatively for each patient.The primary outcomes were determined by the improvement in symptoms and quality of life.Secondary outcome measures were operating time,postoperative length of stay,morbidity and mortality,improvement of pelvic floor structure,and patient satisfaction.RESULTS Four patients underwent robotic-assisted surgery,and two patients underwent a laparoscopic-assisted procedure.The mean operating time for the robotic approach was 243 min(range 160–300 min),and the mean operating time for the laparoscopic approach was 230 min(range 220-240 min).The mean postoperative length of stay was 8.2 d(range 6-12 d).There was no conversion to open procedure and no postoperative mortality.No urinary retention,wound infection,prolonged ileus,pelvic infection and anastomosis leakage occurred.Six patients were followed up for 36 mo.The WCS,ODS,and Patients Assessment of Constipation Quality of Life score improved significantly postoperatively(P<0.05).The WCS and ODS scores showed the best remission and stabilization at 6 to 12 mo after surgery.There was no recurrence or novel constipation after surgery.None of the patients used laxative medication.CONCLUSION Robotic and laparoscopic-assisted ventral rectopexy with colectomy is a safe and effective procedure for selected patients with ODS.However,comprehensive preoperative evaluation and careful patient selection are essential.

Current status of laparoscopic and robotic ventral mesh rectopexy for external and internal rectal prolapse

External and internal rectal prolapse with their affiliated rectocele and enterocele, are associated with debilitating symptoms such as obstructed defecation, pelvic pain and faecal incontinence. Since perineal procedures are associated with a higher recurrence rate, an abdominal approach is commonly preferred. Despite the description of greater than three hundred different procedures, thus far no clear superiority of one surgical technique has been demonstrated. Ventral mesh rectopexy(VMR) is a relatively new and promising technique to correct rectal prolapse. In contrast to the abdominal procedures of past decades, VMR avoids posterolateral rectal mobilisation and thereby minimizes the risk of postoperative constipation. Because of a perceived acceptable recurrence rate, good functional results and low mesh-related morbidity in the short to medium term, VMR has been popularized in the past decade. Laparoscopic or robotic-assisted VMR is now being progressively performed internationally and several articles and guidelines propose the procedure as the treatment of choice for rectal prolapse. In this article, an outline of the current status of laparoscopic and robotic ventral mesh rectopexy for the treatment of internal and external rectal prolapse is presented.

External rectal prolapse:abdominal or perineal repair for men?A retrospective cohort study

Background:External rectal prolapse is a relatively rare disease,in which male patients account for a minority.The selection of abdominal repair or perineal repair for male patients has rarely been investigated.Methods:Fifty-one male patients receiving abdominal repair(laparoscopic ventral rectopexy)or perineal repair(Delorme or Altemeier procedures)at the Sixth Affiliated Hospital of Sun Yat-sen University(Guangzhou,China)between March 2013 and September 2019 were retrospectively analysed.We compared the recurrence,complication rate,post-operative defecation disorder,length of stay,and quality of life between the abdominal and perineal groups.Results:Of the 51 patients,45 had a complete follow-up,with a median of 48.5 months(range,22.8–101.8 months).A total of 35 patients were under age 40 years.The complication rate associated with abdominal repair was less than that associated with perineal repair(0%vs 20.7%,P=0.031)and the recurrence rate was also lower(9.5%vs 41.7%,P=0.018).Multivariate analysis showed that perineal repair(odds ratio,9.827;95%confidence interval,1.296–74.50;P=0.027)might be a risk factor for recurrence.Moreover,only perineal repair significantly improved post-operative constipation status(preoperative vs post-operative,72.4%vs 25.0%,P=0.001).There was no reported mortality in either of the groups.No patient’s sexual function was affected by the surgery.Conclusions:Both surgical approaches were safe in men.Compared with perineal repair,the complication rate and recurrence rate for abdominal repair were lower.However,perineal repair was better able to correct constipation.