LAPAROSCOPIC RECTOPEXY FOR COMPLETE RECTAL PROLAPSE: AN EARLY EXPERIENCE | ||
| The Egyptian Journal of Surgery | ||
| Volume 22, Issue 1, January 2003, Pages 53-58 PDF (333.66 K) | ||
| Document Type: Original Article | ||
| DOI: 10.21608/ejsur.2003.374706 | ||
| Author | ||
| Ayman M. Hassanien* | ||
| General surgery department – El-Minia University Hospital | ||
| Abstract | ||
| Complete rectal prolapse is defined as the protrusion of all layers of the rectal wall through the anal sphincter complex. It occurs mainly in women and is associated with weakness of the pelvic wall musculature and hypotonic anal sphincters attributed to stretching of the pudendal nerves during rectal descent. The present study describes the technique of laparoscopic rectopexy and the clinical outcome. Between June 1999 and September 2001, 31 consecutive patients (26 women 83.8% and 5 men 16.2%) with complete rectal prolapse were treated by laparoscopic rectopexy in El Minia university hospital. The median age of patients was 63 years (range 25 – 79 years). The median time of procedure was 120 minutes (range, 50-150 minutes). Conversion from laparoscopic to laparotomic rectopexy occurred in one case (3.3%). It was the first case in this study. The conversion was due to severe bleeding due to overdissection of the rectum. The bleeding was from presacral venous plexus and controlled during open surgery. Blood loss was less than 100 cc in every case except the first case in which 1000 cc was lost and was replaced by blood transfusion. Return of bowel movements appeared at 24 hour postoperatively, with passage of stools at the fourth postoperative day (2-5). The time to oral intake of solid food was 24 hour in all patients. Opiate analgesia was needed by all patients during the first 12 hours. Median hospital stay was 5 days (range 3 –10 days). Incontinence was reported in 22 patients (70.9%). Eighteen patients (58.1%) were grade 2, three patients (9.7%), were grade 3 and one patient (3.3%) was grade 4. Postoperatively there was an improvement in 19 of 22 patients (86.4%) among those with continence grade 2 or more (P<0.05). Three patients (13.6%) remained incontinent. No patient became more incontinent after surgery. In Conclusion the rectal prolapse can be treated successfully by laparoscopic rectopexy. It is a technically feasable, safe, effective and offers a minimally invasive approach. Symptoms of incontinence were improved in the majority of patients, where as constipation was not improved. Conversion rate was rare. So laparoscopic rectopexy is considered the method of choice choice in patients with complete rectal prolapse. | ||
| Keywords | ||
| Laparoscopy; Complete rectal prolapse | ||
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