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International Journal of Colorectal Disease
Published in: International Journal of Colorectal Disease 11/2017

01-11-2017 | Original Article

Should we offer ventral rectopexy to patients with recurrent external rectal prolapse?

Authors: Brooke Gurland, Maria Emilia Carvalho e Carvalho, Beri Ridgeway, Marie Fidela R. Paraiso, Tracy Hull, Massarat Zutshi

Published in: International Journal of Colorectal Disease | Issue 11/2017

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Abstract

Background

For patients with rectal prolapse undergoing Ventral Rectopexy (VR), the impact of prior prolapse surgery on prolapse recurrence is not well described.

Purpose

The purpose of this study was to compare recurrence rates after VR in patients undergoing primary and repeat rectal prolapse repairs.

Design

This study is a prospective cohort study.

Methods

IRB-approved prospective data registry of consecutive patients undergoing VR for full-thickness external rectal prolapse between 2009 and 2015.

Main outcome measures

Rectal prolapse recurrence was defined as either external prolapse through the anal sphincters or symptomatic rectal mucosa prolapse warranting additional surgery. Preoperative and postoperative morbidity and functional outcomes were analyzed. Actuarial recurrence rates were calculated using the Kaplan-Meier method.

Results

A total of 108 VRs were performed during the study period. Seventy-two were primary and 36 repeat repairs. Seven cases were open, 23 laparoscopic, and 78 robotic. Six cases were converted from laparoscopic/robotic to open. In 63 patients, VR was combined with gynecological procedures. There were no statistical differences between primary or recurrent prolapse for the following: demographics, operative time, concomitant gynecologic procedures, complications, blood loss, and graft material type. Length of stay was longer in patients with a history of prior prolapse surgery (p = 0.01). Prolapse recurrence rates for primary repairs were reported at 1.4, 6.9, and 9.7% and for recurrent prolapse procedures 13.9, 25, and 25% at 1, 3, and 5 years (p = 0.13). Mean length of follow-up was similar between groups. Time to recurrence was significantly shorter in patients undergoing repeat prolapse surgery 8.8 vs 30.7 months (p = 0.03).

Conclusions

VR is a better option for patients undergoing primary rectal prolapse repair.
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Metadata
Title
Should we offer ventral rectopexy to patients with recurrent external rectal prolapse?
Authors
Brooke Gurland
Maria Emilia Carvalho e Carvalho
Beri Ridgeway
Marie Fidela R. Paraiso
Tracy Hull
Massarat Zutshi
Publication date
01-11-2017
Publisher
Springer Berlin Heidelberg
Published in
International Journal of Colorectal Disease / Issue 11/2017
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI
https://doi.org/10.1007/s00384-017-2858-9

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