Published online Apr 28, 2015. doi: 10.3748/wjg.v21.i16.5049
Peer-review started: May 27, 2014
First decision: July 9, 2014
Revised: December 21, 2014
Accepted: February 11, 2015
Article in press: February 11, 2015
Published online: April 28, 2015
AIM: To assess effectiveness, complications, recurrence rate, and recent improvements of the anterior rectopexy procedure for treatment of total rectal prolapse.
METHODS: MEDLINE, PubMed, EMBASE, and other relevant database were searched to identify studies. Randomized controlled trials, non-randomized studies and original articles in English language, with more than 10 patients who underwent laparoscopic ventral rectopexy for full-thickness rectal prolapse, with a follow-up over 3 mo were considered for the review.
RESULTS: Twelve non-randomized case series studies with 574 patients were included in the review. No surgical mortality was described. Conversion was needed in 17 cases (2.9%), most often due to difficult adhesiolysis. Twenty eight patients (4.8%) presented with major complications. Seven (1.2%) mesh-related complications were reported. Most frequent complications were urinary tract infection and urinary retention. Mean recurrence rate was 4.7% with a median follow-up of 23 mo. Improvement of constipation ranged from 3%-72% of the patients and worsening or new onset occurred in 0%-20%. Incontinence improved in 31%-84% patients who presented fecal incontinence at various stages. Evaluation of functional score was disparate between studies.
CONCLUSION: Based on the low long-term recurrence rate and favorable outcome data in terms of low de novo constipation rate, improvement of anal incontinence, and low complications rate, laparoscopic anterior rectopexy seems to emerge as an efficient procedure for the treatment of patients with total rectal prolapse.
Core tip: Several procedures have been described to correct full-thickness rectal prolapse. They can be separate into abdominal procedures and perineal procedures. Laparoscopic anterior rectopexy has become the procedure of choice for the treatment of total rectal prolapse in many colorectal surgical teams. This review assesses effectiveness, morbidity, recurrence rate, and recent improvements of the technique.