Skip to main content
Erschienen in: International Journal of Colorectal Disease 10/2014

01.10.2014 | Original Article

Laparoscopic ventral rectopexy in an elderly population with external rectal prolapse: clinical and anal manometric results

verfasst von: Trine Bjerke, Tommie Mynster

Erschienen in: International Journal of Colorectal Disease | Ausgabe 10/2014

Einloggen, um Zugang zu erhalten

Abstract

Aim

We report the clinical and anal manometric results of elderly patients treated with laparoscopic ventral rectopexy (LVR) for full-thickness rectal prolapse.

Method

From March 2009 to June 2012, patients were consecutively included. A modified laparoscopic Orr-Loygue procedure with posterior mobilisation was used. The patients were evaluated preoperatively, 2 months postoperatively and after 1 year. We registered Wexner incontinence scores and laxative uses by a questionnaire and performed simple anal manometry.

Results

A total of 46 patients underwent operation, all women. The median age was 83 years (range 34–99), median prolapse size was 8 cm (range 2–15), and 30 % had previous prolapse surgery. The median operative time was 135 min (range 90–215), and the median length of stay was 2 days (range 1–14). The 30-day morbidity rate was 15 %, and there were two (4 %) deaths within 30 days. There was a significant reduction in incontinence scores after 2 months and 1 year. The anal resting pressures improved from 10 cm H2O slightly to 16 cm H2O after 2 months, significantly, and still significant after 1 year at 13 cm H2O. There were no changes in the use of laxatives. The median follow-up time was 1.5 years (range 0.5–3), and there were two prolapse recurrences (4 %) in this period.

Conclusions

Laparoscopic ventral rectopexy with posterior mobilisation seems to be effective and relatively well tolerated, although not without mortality in elderly debilitated patients. It improves incontinence. With increased life-year expectance, these patients may benefit from a lower risk of recurrence compared with perineal procedures.
Literatur
1.
Zurück zum Zitat Tou S BS, Malik AI, Nelson RL. Surgery for complete rectal prolapse in adults. Cochrane Database Syst Rev 2008. Tou S BS, Malik AI, Nelson RL. Surgery for complete rectal prolapse in adults. Cochrane Database Syst Rev 2008.
2.
Zurück zum Zitat Sajid MSSM, Baig MK (2010) Open vs laparoscopic repair of full-thickness rectal prolapse: a re-meta-analysis. Colorectal Dis 12:515–525PubMedCrossRef Sajid MSSM, Baig MK (2010) Open vs laparoscopic repair of full-thickness rectal prolapse: a re-meta-analysis. Colorectal Dis 12:515–525PubMedCrossRef
3.
4.
Zurück zum Zitat Carpelan-Holmstöm MKO, Scheinin T (2006) Laparoscopic rectal prolapse surgery combined with short hospital stay is safe in elderly and debilitated patients. Surg Endosc 20:1353–1359CrossRef Carpelan-Holmstöm MKO, Scheinin T (2006) Laparoscopic rectal prolapse surgery combined with short hospital stay is safe in elderly and debilitated patients. Surg Endosc 20:1353–1359CrossRef
5.
Zurück zum Zitat Wijffels NCC, Dixon A, Greenslade G, Lindsey I (2011) Laparoscopic ventral rectopexy for external rectal prolapse is safe and effective in the elderly. Does this make perineal procedures obsolete? Colorectal Dis 13:561–566PubMedCrossRef Wijffels NCC, Dixon A, Greenslade G, Lindsey I (2011) Laparoscopic ventral rectopexy for external rectal prolapse is safe and effective in the elderly. Does this make perineal procedures obsolete? Colorectal Dis 13:561–566PubMedCrossRef
6.
Zurück zum Zitat Byrne CMSS, Solomon MJ, Young JM, Eyers AA, Young CJ (2008) Long-term functional outcomes after laparoscopic and open rectopexy for the treatment of rectal prolapse. Dis Colon Rectum 51:1597–1604PubMedCrossRef Byrne CMSS, Solomon MJ, Young JM, Eyers AA, Young CJ (2008) Long-term functional outcomes after laparoscopic and open rectopexy for the treatment of rectal prolapse. Dis Colon Rectum 51:1597–1604PubMedCrossRef
7.
Zurück zum Zitat Aitola PTHK, Matikainen MJ (1999) Functional results of operative treatment of rectal prolapse over an 11-year period. Emphasis on transabdominal approach. Dis Colon Rectum 42:655–660PubMedCrossRef Aitola PTHK, Matikainen MJ (1999) Functional results of operative treatment of rectal prolapse over an 11-year period. Emphasis on transabdominal approach. Dis Colon Rectum 42:655–660PubMedCrossRef
8.
Zurück zum Zitat Boons PCR, Cunningham C, Lindsey I (2010) Laparoscopic ventral rectopexy for external rectal prolapse improves constipation and avoids de novo constipation. Colorectal Dis 12:526–532PubMedCrossRef Boons PCR, Cunningham C, Lindsey I (2010) Laparoscopic ventral rectopexy for external rectal prolapse improves constipation and avoids de novo constipation. Colorectal Dis 12:526–532PubMedCrossRef
9.
10.
Zurück zum Zitat Simpson RRKM, Ngyen MH, Dinning PG, Lubowski DZ (2006) Anal manometry: a comparison of techniques. Dis Colon Rectum 49:1033–1038PubMedCrossRef Simpson RRKM, Ngyen MH, Dinning PG, Lubowski DZ (2006) Anal manometry: a comparison of techniques. Dis Colon Rectum 49:1033–1038PubMedCrossRef
11.
Zurück zum Zitat Loygue JNB, Cunci O, Malafosse M, Huguet C, Parc R (1984) Rectopexy to the promontory for the treatment of rectal prolapse. Dis Colon Rectum 27:356–359PubMedCrossRef Loygue JNB, Cunci O, Malafosse M, Huguet C, Parc R (1984) Rectopexy to the promontory for the treatment of rectal prolapse. Dis Colon Rectum 27:356–359PubMedCrossRef
12.
Zurück zum Zitat Ratelle RVS, Péloquin AB, Gravel D (1994) Abdominal rectopexy (Orr-Loygue) in rectal prolapse: celioscopic approach or conventional surgery. Ann Chir 1994:679–684 Ratelle RVS, Péloquin AB, Gravel D (1994) Abdominal rectopexy (Orr-Loygue) in rectal prolapse: celioscopic approach or conventional surgery. Ann Chir 1994:679–684
13.
Zurück zum Zitat Kariv YDC, Casillas S, Hammel J, Nocero J, Bast J, Brady K, Fazio VW, Senagore AJ (2006) Long-term outcome after laparoscopic and open surgery for rectal prolapse: a case–control study. Surg Endosc 20:35–42PubMedCrossRef Kariv YDC, Casillas S, Hammel J, Nocero J, Bast J, Brady K, Fazio VW, Senagore AJ (2006) Long-term outcome after laparoscopic and open surgery for rectal prolapse: a case–control study. Surg Endosc 20:35–42PubMedCrossRef
14.
Zurück zum Zitat Solomon MJYC, Eyers AA, Roberts RA (2002) Randomized clinical trial of laparoscopic versus open abdominal rectopexy for rectal prolapse. Br J Surg 89:35–39PubMedCrossRef Solomon MJYC, Eyers AA, Roberts RA (2002) Randomized clinical trial of laparoscopic versus open abdominal rectopexy for rectal prolapse. Br J Surg 89:35–39PubMedCrossRef
15.
Zurück zum Zitat Kairaluoma MVVM, Kellokumpu IH (2003) Open vs. laparoscopic surgery for rectal prolapse. Dis Colon Rectum 46:353–360PubMedCrossRef Kairaluoma MVVM, Kellokumpu IH (2003) Open vs. laparoscopic surgery for rectal prolapse. Dis Colon Rectum 46:353–360PubMedCrossRef
16.
Zurück zum Zitat Purkayastha STP, Athanasiou T, Aziz O, Paraskevas P, Ziprin P, Darzi A (2005) A comparison of open vs. laparoscopic abdominal rectopexy for full-thickness rectal prolapse: a meta-analysis. Dis Colon Rectum 48:1930–1940PubMedCrossRef Purkayastha STP, Athanasiou T, Aziz O, Paraskevas P, Ziprin P, Darzi A (2005) A comparison of open vs. laparoscopic abdominal rectopexy for full-thickness rectal prolapse: a meta-analysis. Dis Colon Rectum 48:1930–1940PubMedCrossRef
17.
Zurück zum Zitat D’Hoore ACR, Penninckx F (2004) Long-term outcome of laparoscopic ventral rectopexy for total rectal prolapse. Br J Surg 91:1500–1505PubMedCrossRef D’Hoore ACR, Penninckx F (2004) Long-term outcome of laparoscopic ventral rectopexy for total rectal prolapse. Br J Surg 91:1500–1505PubMedCrossRef
18.
Zurück zum Zitat Boccasanta PVM, Reitano MC, Salamina G, Rosati R, Montorsi M, Fichera G, Strinna M, Peracchia A (1999) Laparotomic vs. laparoscopic rectopexy in complete rectal prolapse. Dig Surg 16:415–419PubMedCrossRef Boccasanta PVM, Reitano MC, Salamina G, Rosati R, Montorsi M, Fichera G, Strinna M, Peracchia A (1999) Laparotomic vs. laparoscopic rectopexy in complete rectal prolapse. Dig Surg 16:415–419PubMedCrossRef
19.
Zurück zum Zitat Salkeld GBM, Solomon M (2004) Economic impact of laparoscopic versus open abdominal rectopexy. Br J Surg 91:1188–1191PubMedCrossRef Salkeld GBM, Solomon M (2004) Economic impact of laparoscopic versus open abdominal rectopexy. Br J Surg 91:1188–1191PubMedCrossRef
20.
Zurück zum Zitat Cunin DSL, Desfourneaux V, Bouteloup PY, Meunier B, Ropert A, Berkelmans I, Bretagne JF, Boudjema K, Bouguen G (2013) Incontinence in full-thickness rectal prolapse: low level of improvement after laparoscopic rectopexy. Colorectal Dis 15:470–476PubMedCrossRef Cunin DSL, Desfourneaux V, Bouteloup PY, Meunier B, Ropert A, Berkelmans I, Bretagne JF, Boudjema K, Bouguen G (2013) Incontinence in full-thickness rectal prolapse: low level of improvement after laparoscopic rectopexy. Colorectal Dis 15:470–476PubMedCrossRef
21.
Zurück zum Zitat Ryhammer AMLC, Sørensen FH (1997) Effects of age on anal function in normal women. Int J Colorectal Dis 12:225–229PubMedCrossRef Ryhammer AMLC, Sørensen FH (1997) Effects of age on anal function in normal women. Int J Colorectal Dis 12:225–229PubMedCrossRef
22.
Zurück zum Zitat Huber FTSH, Siewert JR (1995) Functional results after treatment of rectal prolapse with rectopexy and sigmoid resection. World J Surg 19:138–143PubMedCrossRef Huber FTSH, Siewert JR (1995) Functional results after treatment of rectal prolapse with rectopexy and sigmoid resection. World J Surg 19:138–143PubMedCrossRef
23.
Zurück zum Zitat Mollen RMKJ, van Hoek F (2000) Effects of rectal mobilization and lateral ligaments division on colonic and anorectal function. Dis Colon Rectum 43:1283–1287PubMedCrossRef Mollen RMKJ, van Hoek F (2000) Effects of rectal mobilization and lateral ligaments division on colonic and anorectal function. Dis Colon Rectum 43:1283–1287PubMedCrossRef
24.
Zurück zum Zitat Jonkers HAPN, Draaisma WA, Broeders IA, Consten EC (2013) Laparoscopic ventral rectopexy for rectal prolapse and symptomatic rectocele: an analysis of 245 consecutive patients. Colorectal Dis 15:695–699CrossRef Jonkers HAPN, Draaisma WA, Broeders IA, Consten EC (2013) Laparoscopic ventral rectopexy for rectal prolapse and symptomatic rectocele: an analysis of 245 consecutive patients. Colorectal Dis 15:695–699CrossRef
25.
Zurück zum Zitat Samaranayake CBLC, Plank AW, Merrie AE, Plank LD, Bissett IP (2010) Systematic review on ventral rectopexy for rectal prolapse and intussusception. Colorectal Dis 12:504–514PubMedCrossRef Samaranayake CBLC, Plank AW, Merrie AE, Plank LD, Bissett IP (2010) Systematic review on ventral rectopexy for rectal prolapse and intussusception. Colorectal Dis 12:504–514PubMedCrossRef
Metadaten
Titel
Laparoscopic ventral rectopexy in an elderly population with external rectal prolapse: clinical and anal manometric results
verfasst von
Trine Bjerke
Tommie Mynster
Publikationsdatum
01.10.2014
Verlag
Springer Berlin Heidelberg
Erschienen in
International Journal of Colorectal Disease / Ausgabe 10/2014
Print ISSN: 0179-1958
Elektronische ISSN: 1432-1262
DOI
https://doi.org/10.1007/s00384-014-1960-5

Weitere Artikel der Ausgabe 10/2014

International Journal of Colorectal Disease 10/2014 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

CME: 2 Punkte

Prof. Dr. med. Gregor Antoniadis Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

CME: 2 Punkte

Dr. med. Benjamin Meyknecht, PD Dr. med. Oliver Pieske Das Webinar S2e-Leitlinie „Distale Radiusfraktur“ beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

CME: 2 Punkte

Dr. med. Mihailo Andric
Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.