LAPAROSCOPIC RECTOPEXY WITH OR WITHOUT SIGMOIDECTOMY FOR REPAIR OF COMPLETE RECTAL PROLAPSE

SUMMARY AND CONCLUSIONRectal prolapse is a condition that has been fascinated surgeons for a long time.Despite its long recognition, the etiology & pathogenesis of true rectal prolapse remain controversial. But it is recognized that associated functional problems, such as incontinence and constipation, are common. Also the management of prolapse remains a challenging condition as there’s no single ideal surgical treatment has been identified.There should be two primary objectives in treating these patients. The first is to carry out a procedure that safely corrects the prolapse with minimal morbidity, without mortality and with least recurrence rates, with preserving rectal, urinary and sexual functions. The second is to cure or significantly improve the associated incontinence and the underlying defecation disorder.This study included ten patients with complete rectal prolapse, 6 patients had constipation and 4 had incontinence.All patients were submitted to full clinical examination, sigmoidoscopy, barium enema and anorectal manometry. 4 patients had redundant sigmoid colon and were operated by resection rectopexy. The remaining 6 patients were operated by rectopexy alone, 2 with mesh and 4 with suture rectopexy.Postoperativly constipation was improved in 83% of patients and the improvement was more in the resection rectopexy than in mesh or suture rectopexy. While incontinence improved in 75% of patients regardless which method was used.Resection rectopexy and mesh or suture rectopexy through open laparotomy are established procedures for treatment of rectal prolapse, however the laparoscopic approach showed lower morbidity, early return of bowel function, less postoperative pain, better cosmosis and shorter hospital stay.The conclusion of this study is:• Laparoscopic rectopexy and laparoscopic assisted resection rectopexy are feasible and carry an acceptable morbidity rate. They eliminate prolapse and cure incontinece and constipation in the great majority of patients.• Also the addition of sigmoid resection to laparoscopic rectopexy is safe and contribute to decrease the risk of severe constipation postoperatively.• Laparoscopic mesh rectopexy show no advantage over the suture technique which is used now as the fixation method of choice.