Proficiency gain curve and predictors of outcome for laparoscopic ventral mesh rectopexy

doi:10.1016/j.surg.2014.03.008

Surgery

Volume 156, Issue 1, July 2014, Pages 158-167

https://doi.org/10.1016/j.surg.2014.03.008 Get rights and content

Background

Laparoscopic ventral mesh rectopexy (LVMR) is a well-recognized treatment for rectal prolapse and high-grade rectal intussusception. However, it is technically complex with the possibility of clinically relevant morbidity. The objectives were to define (i) the efficacy and safety of LVMR, (ii) risk factors for poor clinical outcome, and (iii) the autodidactic proficiency gain curve.

Methods

All primary LVMR cases performed by the senior author between January 1997 and February 2013 were included in the study. In addition to the clinical outcomes, quality-of-life outcomes, including the Cleveland Clinic Incontinence Score and obstructive defecation syndrome score, were evaluated. Risk factors for operative complications, recurrence, and mesh-related complications were identified by the use of logistic regression models. Proficiency gain curves for functional and clinical outcomes were assessed using cumulative sum curves.

Results

A total of 636 LVMRs were performed during the study period. The mean percentage improvement in the Cleveland Clinic Incontinence Score and obstructive defecation syndrome score were 89.7% (SD 21.8%) and 56.7% (SD 20.6%). The operative complication, recurrent symptoms, and mesh-related complication rates were 9.9%, 9.4%, and 3.1%, respectively. Predictors of operative complication were male sex and previous abdominal operation; the only predictor of mesh-related complications and recurrence was the use of polyester mesh. The learning curve for operative time was 54 cases, but for other clinical and quality-of-life outcomes was between 82 and 105 cases.

Conclusion

LVMR treats rectal prolapse effectively, providing good symptomatic relief with minimal morbidity. However, the self-taught learning curve for this complex laparoscopic procedure is protracted.

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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Original CommunicationProficiency gain curve and predictors of outcome for laparoscopic ventral mesh rectopexy

Background

Methods

Results

Conclusion

Section snippets

Methods

Patient characteristics

Discussion

BJOG

Urology

Laparoscopic ventral rectopexy, posterior colporrhaphy and vaginal sacrocolpopexy for the treatment of recto-genital prolapse and mechanical outlet obstruction

Colorectal Dis

Surgery for complete rectal prolapse in adults

Cochrane Database Syst Rev

Laparoscopic ventral rectopexy for external rectal prolapse improves constipation and avoids de novo constipation

Colorectal Dis

Laparoscopic ventral rectopexy for internal rectal prolapse: short-term functional results

Colorectal Dis

Laparoscopic resection rectopexy for rectal prolapse: a single-center study during 16 years

Surg Endosc

How to deal with complications after laparoscopic ventral mesh rectopexy: lessons learnt from a tertiary referral centre

Colorect Dis

Functional problems in adult rectal prolapse and controversies in surgical treatment

Br J Surg

Original Communication
Proficiency gain curve and predictors of outcome for laparoscopic ventral mesh rectopexy