Objective Objective Full-thickness rectum prolapse causes perineal discomfort, soiling, spotting, mucosal bleeding and anal sphincter incontinence. Treatment of rectal prolapse is surgical. Perineal repairs are well tolerated but are associated with higher recurrence rate. Abdominal repair, fixing the rectum by using mesh or sutures have the lowest recurrence rate. The purpose of our study is to demonstrate the safety and feasibility of laparoscopy in the management of rectal prolapse in adults. Methods Methods From October 2007 to April 2008 ten consecutive patients (all women) median age 51 years (range 23-74) underwent laparoscopic rectopexy to sacrum for a 2 nd (3pts) and 3 rd (7pts) degree prolapse in our institution. Pre-operative evaluation included full proctological examination, endo-anal ultrasound and radiology- proctography. Results Results No conversion to laparotomy was necessary. Complete reduction of rectal prolapse was obtained in all cases. Median operative time was 79 minutes ( range 51 to 112 min.). Antibiotic therapy was given intravenously during 48 hours ( 3,6g/day Amoxicyllin- Clavulanate ). No morbidity was reported. In all cases the anal incontinence and symptoms (soiling, spotting and bleeding) were significantly diminished. In four patients mild constipation was resolved by soft laxatives. Mean hospital stay was 3, 9 days ( range 3, 0 – 5, 1 ). 100% of patients had biofeedback training after the procedure. The follow up was uneventful. The QoL questionnaire showed a satisfactory result in 95% of patients. Technique Conclusions Conclusions Laparoscopy is useful, safe and feasible to resolve a rectal prolapse in adults. It has a low morbidity rate, with clear benefits of reduced length of hospital stay, postoperative pain, wound complications and a higher Delgadillo X. Cespedes Fr. Schöni Ph. Delgadillo X. Cespedes Fr. Schöni Ph. Service de chirurgie - Clinique Montbrillant, La Service de chirurgie - Clinique Montbrillant, La Chaux-de-Fonds Chaux-de-Fonds Switzerland Switzerland Laparoscopy surgery for Laparoscopy surgery for rectal prolapse in adults rectal prolapse in adults Rectal prolapse Well’s procedure was performed in seven patients and Ivalon mesh implanted in 3. Full laparoscopic procedure was achieved applying a synthetic prosthesis for a rectal fixation to the promontory of the sacrum in all patients. 1. D'Hoore A et al. Laparoscopic ventral colpopexy for rectal prolapse (technique- outcome) Surg Endosc 2006 2. Portier G et al. Surgery for rectal prolapse: Orr-Loygue rectopexy. Dis Colon Rectum 2006 3. Solomon MJ et al. Randomized clinical trial of laparoscopic vs open abdominal rectopexy. Br J Surg 2002 4. D'Hoore A et al Long term outcome of laparoscopic ventral rectopexy for rectal prolapse. Br J Surg 2004 Reference Reference s

Objective Objective Full-thickness rectum prolapse causes perineal discomfort, soiling, spotting, mucosal bleeding and anal sphincter incontinence. Treatment

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Page 1: Objective Objective Full-thickness rectum prolapse causes perineal discomfort, soiling, spotting, mucosal bleeding and anal sphincter incontinence. Treatment

ObjectiveObjective Full-thickness rectum prolapse causes perineal discomfort, soiling, spotting, mucosal bleeding and anal sphincter incontinence. Treatment of rectal prolapse is surgical.

Perineal repairs are well tolerated but are associated with higher recurrence rate. Abdominal repair, fixing the rectum by using mesh or sutures have the lowest recurrence rate. The purpose of our study is to demonstrate the safety and feasibility of laparoscopy in the management of rectal prolapse in adults. MethodsMethods From October 2007 to April 2008 ten consecutive patients (all women) median age 51 years (range 23-74) underwent laparoscopic rectopexy to sacrum for a 2nd (3pts) and 3rd (7pts) degree prolapse in our institution. Pre-operative evaluation included full proctological examination, endo-anal ultrasound and radiology-proctography.

Results Results No conversion to laparotomy was necessary. Complete reduction of rectal prolapse was obtained in all cases. Median operative time was 79 minutes ( range 51 to 112 min.). Antibiotic therapy was given intravenously during 48 hours ( 3,6g/day Amoxicyllin-Clavulanate ). No morbidity was reported.

In all cases the anal incontinence and symptoms (soiling, spotting and bleeding) were significantly diminished. In four patients mild constipation was resolved by soft laxatives. Mean hospital stay was 3, 9 days ( range 3, 0 – 5, 1 ). 100% of patients had biofeedback training after the procedure. The follow up was uneventful. The QoL questionnaire showed a satisfactory result in 95% of patients.

Technique

Conclusions Conclusions Laparoscopy is useful, safe and feasible to resolve a rectal prolapse in adults. It has a low morbidity rate, with clear benefits of reduced length of hospital stay, postoperative pain, wound complications and a higher incidence of satisfaction (QoL).

Xavier Delgadillo MD PaD EBSQService de Chirurgie - Clinique Montbrillant

Rue de la Montagne 1- La Chaux-de-Fonds 2300 CHwww.proctologica.com

This poster was printed with the kindly help of Clinic Plastic Products - SuisseClinic Plastic Products - Suisse

Delgadillo X. Cespedes Fr. Schöni Ph.Delgadillo X. Cespedes Fr. Schöni Ph.

Service de chirurgie - Clinique Montbrillant, La Chaux-de-Service de chirurgie - Clinique Montbrillant, La Chaux-de-FondsFonds

SwitzerlandSwitzerland

Laparoscopy surgery for Laparoscopy surgery for rectal prolapse in adultsrectal prolapse in adults

Rectal prolapse

Well’s procedure was performed in seven patients and Ivalon mesh implanted in 3. Full laparoscopic procedure was achieved applying a synthetic prosthesis for a rectal fixation to the promontory of the sacrum in all patients. Finally, a post-operative Quality of Life ( QoL ) questionnaire was stablished.

1. D'Hoore A et al. Laparoscopic ventral colpopexy for rectal prolapse (technique-outcome) Surg Endosc 2006 2. Portier G et al. Surgery for rectal prolapse: Orr-Loygue rectopexy. Dis Colon Rectum 2006 3. Solomon MJ et al. Randomized clinical trial of laparoscopic vs open abdominal rectopexy. Br J Surg 2002 4. D'Hoore A et al Long term outcome of laparoscopic ventral rectopexy for rectal prolapse. Br J Surg 2004

ReferencesReferences