Original CommunicationProficiency gain curve and predictors of outcome for laparoscopic ventral mesh rectopexy
Section snippets
Methods
All consecutive primary LVMR cases, performed by the senior author (A.R.D.) between January 1997 and February 2013, recorded in a prospectively collected database, were included in the study. Only de novo LVMR procedures alone were included in the analysis. Patients with solitary rectal ulcer syndrome and those undergoing additional operations, eg, combined anterior colporraphy, tension-free vaginal tape, mesh removal, or hernia repair, were excluded.
Patient characteristics
In the study period, the senior author performed 764 operations for rectal prolapse or high-grade rectal intussusception and of these, 636 were LVMR without any additional procedure. The median follow-up was 21 months (interquartile range 8–40 months). There were 64 male patients (10.1%), the mean BMI was 26.1 (SD 4.2), and the mean age was 58.4 (SD 15.5) (Table I). There was complete pre- and postoperative data for ODS score in 276 cases, CCIS in 602 cases, BBUSQ-22 at 3 months and 1 year in
Discussion
This article describes the largest case series of LVMR cases published to date. It confirms that LVMR is a safe and effective procedure, which not only reduces the anatomical defect but also improves the symptoms of incontinence and obstructive defecation in the majority of patients. To aid case selection, predictors of adverse clinical outcomes were identified and the autodidactic proficiency gain curve for LVMR has been described for the first time.
The improvement seen in the CCIS, ODS, and
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