Skip to main content
SpringerLink
Log in

Outcome of laparoscopic rectopexy versus perineal rectosigmoidectomy for full-thickness rectal prolapse in elderly patients

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

The balance between abdominal and perineal approaches for rectal prolapse is always the higher morbidity but better outcome in the former setting. Therefore, perineal approaches have been preferred for the treatment of full-thickness rectal prolapse (FTRP) in elderly patients. However, laparoscopic rectopexy with or without resection also may be used for elderly patients and may confer the same benefits.

Purpose

The objective of this study was to evaluate safety and efficacy of laparoscopic rectopexy compared with perineal rectosigmoidectomy for FTRP in elderly patients.

Methods

Between July 2000 and June 2009, eight consecutive patients (8 women; mean age, 71 (range, 65–77) years) with FTRP underwent laparoscopic rectopexy (LAP group). During the same period, 143 patients underwent perineal rectosigmoidectomy (PRS group). A total of 123 patients were selected who underwent perineal rectosigmoidectomy (117 women; mean age, 80.7 (range, 66–98) years).

Results

Three patients (37.5%) in the LAP group and 29 patients (23.6%) in the PRS group had undergone previous operations for rectal prolapse. The mean follow-up periods were 6.9 months and 12.8 months, respectively. In the LAP group, operative time was longer (166.5 vs. 73.5 minutes; p > 0.05) and bleeding loss was more (101.7 vs. 31.6; p < 0.05), whereas the length of hospitalization was same between the two groups (5.4 vs. 5.3 days; p > 0.05). Postoperative complications included an incisional hernia in the LAP group (12.5%) and urinary retention (4.8%), anastomotic disruption (2.4%), urinary tract infection (1.6%), and atelectasis (1.6%) in the PRS group (13.8%). Recurrences were 1 (12.5%) in the LAP group and 14 (11.4%) in the PRS group.

Conclusions

Laparoscopic rectopexy is a safe and feasible procedure in elderly patients with FTRP but results in increased operative time.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Aitola PT, Hiltunen KM, Matikainen MJ (1992) Functional results of operative treatment of rectal prolapse over an 11-year period: emphasis on transabdominal approach. Dis Colon Rectum 42:655–660

    Article  Google Scholar 

  2. Deen KI, Grant E, Billingham C, Keighley MR (1994) Abdominal resection rectopexy with pelvic floor repair versus perineal rectosigmoidectomy and pelvic floor repair for full-thickness rectal prolapse. Br J Surg 81:302–304

    Article  PubMed  CAS  Google Scholar 

  3. Kim DS, Tsang CB, Wong WD, Lowry AC, Goldberg SM, Madoff RD (1999) Complete rectal prolapse: evolution of management and results. Dis Colon Rectum 42:460–469

    Article  PubMed  CAS  Google Scholar 

  4. Madiba TE, Baig MK, Wexner SD (2005) Surgical management of rectal prolapse. Arch Surg 140:63–73

    Article  PubMed  Google Scholar 

  5. Altemeier WA, Gulbertson WR, Schowengerdt C, Hunt J (1971) Nineteen years’ experience with one-stage perineal repair rectal prolapse. Ann Surg 173:993–1006

    Article  PubMed  CAS  Google Scholar 

  6. Zbar AP, Takashima S, Hasegawa T, Kitabayashi K (2002) Perineal rectosigmoidectomy (Altemeier’s procedure): a review of physiology technique and outcome. Tech Coloproctol 2:106–116

    Google Scholar 

  7. Baker R, Senagore AJ, Luchtefeld MA (1995) Laparoscopic-assisted vs. open resection. Rectopexy offers excellent results. Dis Colon Rectum 38:199–201

    Article  PubMed  CAS  Google Scholar 

  8. Solomon MJ, Young CJ, Eyers AA, Roberts RA (2002) Randomized clinical trial of laparoscopic vs. open abdominal rectopexy for rectal prolapse. Br J Surg 89:35–39

    Article  PubMed  CAS  Google Scholar 

  9. Kairaluoma MV, Viljakka MT, Kellokumpu IH (2003) Open vs. laparoscopic surgery for rectal prolapse: a case-controlled study assessing short-term outcome. Dis Colon Rectum 46:353–360

    Article  PubMed  Google Scholar 

  10. Kariv Y, Delaney CP, Casillas S, Hammel J, Nocero J, Bast J, Brady K, Fazio VW, Senogore AJ (2006) Long-term outcome after laparoscopic and open surgery for rectal prolapse. Surg Endosc 20:35–42

    Article  PubMed  CAS  Google Scholar 

  11. Frasson M, Braga M, Vignali A, Auliani W, Di Carlo V (2008) Benefits of laparoscopic colorectal resection are more pronounced in elderly patients. Dis Colon Rectum 51:296–300

    Article  PubMed  Google Scholar 

  12. Person B, Cera SM, Sands DR, Weiss EG, Vernava AM, Nogueras JJ, Wexner SD (2008) Do elderly patients benefit from laparoscopic colorectal surgery? Surg Endosc 22:401–405

    Article  PubMed  CAS  Google Scholar 

  13. Kaiwa Y, Kurokawa Y, Namiki K, Myojin T, Ansai M, Satomi S (2004) Outcome of laparoscopic rectopexy for complete rectal prolapse in patients older than 70 years versus younger patients. Surg Today 34:742–746

    Article  PubMed  Google Scholar 

  14. Byrne CM, Smith SR, 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 51:1597–1604

    Article  PubMed  Google Scholar 

  15. Demirbas S, Akin ML, Kalemoglu M, Ogun I, Celenk T (2005) Comparison of laparoscopic and open surgery for total rectal prolapse. Surg Today 35:446–452

    Article  PubMed  Google Scholar 

  16. Carpelan-Holmstrom M, Kruuna O, Scheinin T (2006) Laparoscopic rectal prolapse surgery combined with short hospital stay is safe in elderly and debilitated patients. Surg Endosc 20:1353–1359

    Article  PubMed  CAS  Google Scholar 

  17. Raftopoulos Y, Senagore AJ, Di Giuro G, Bergamaschi R (2005) Recurrence rates after abdominal surgery for complete rectal prolapse: a multicenter pooled analysis of 643 individual patient data. Dis Colon Rectum 48:1200–1206

    Article  PubMed  Google Scholar 

Download references

Disclosures

Steven D. Wexner is a consultant for Covidien and for Karl Storz Endoscopy. He is also entitled to receive inventors income from Karl Storz Endoscopy. Drs. Seung-Hyun Lee, Paryush Lakhtaria, Jorge Canedo, and Yoon-Suk Lee, have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. Department of Colorectal Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Boulevard, Weston, FL, 33331, USA

    Seung-Hyun Lee, Paryush Lakhtaria, Jorge Canedo, Yoon-Suk Lee & Steven D. Wexner

Authors
  1. Seung-Hyun Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Paryush Lakhtaria
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jorge Canedo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yoon-Suk Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Steven D. Wexner
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Steven D. Wexner.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lee, SH., Lakhtaria, P., Canedo, J. et al. Outcome of laparoscopic rectopexy versus perineal rectosigmoidectomy for full-thickness rectal prolapse in elderly patients. Surg Endosc 25, 2699–2702 (2011). https://doi.org/10.1007/s00464-011-1632-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-011-1632-2

Keywords

Search

Navigation